Billing Optimization Analyst

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 10%

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Med-Metrix

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2010

🏥 Healthcare

☁️ SaaS

💰 Private equity on 2025-09

Healthcare • SaaS

Med-Metrix is a company for which only a minimal web presence was provided (the page only displayed "Loading application... Your web browser must have JavaScript enabled... "). No product, market, or mission details were included in the supplied text. Based on the company name alone, it plausibly focuses on medical or clinical metrics, analytics, or healthcare software, but that is speculative and not confirmed by the provided information. Further public details would be required to be more specific.

📋 Description

• Serve as the subject matter expert for the hospital claim-generation lifecycle, from final coding and charge capture through claim creation, validation, and transmission • Research and resolve complex billing edits, claim splits, bill holds, rejections, late charges, stop bills, and other exceptions that delay claims from being released • Interpret and apply Medicare, Medicaid, managed care, and commercial payer billing requirements for complex or non-standard scenarios • Analyze recurring claim barriers and determine root causes across processes, system configuration, payer rules, and upstream workflows • Lead working sessions with billing leaders and team members to review billing scenarios, present findings, and agree on resolution steps and owners • Partner with operational, clinical, reimbursement, coding, IT, and vendor teams to improve edits, work queues, workflows, and escalation processes • Monitor first-pass clean-claim rate, bill-hold days, DNFB, rejection trends, and billing throughput to confirm improvements are sustained and identify additional opportunities • Develop billing guidance, standard work, and education based on root-cause findings to prevent recurrence and drive team consistency • Advise billing and client leadership on billing risks, priorities, and financial impact of recommended changes • Use, protect, and disclose patients’ PHI only in accordance with HIPAA standards • Understand and comply with Information Security and HIPAA policies and procedures • Limit viewing of PHI to the minimum necessary to perform assigned duties • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree in healthcare administration, business, finance, or a related field; an equivalent combination of education and progressive hospital billing experience will be considered • 4+ years of progressive hospital billing experience, including hands-on resolution of complex claims before submission and leading the resolution of recurring billing issues • Advanced knowledge of the end-to-end institutional claim lifecycle, including claim edits, split-billing scenarios, bill holds, rejections, late charges, stop bills, and corrected or replacement claims • In-depth knowledge of Medicare, Medicaid, managed care, and commercial payer billing rules, claim formats, and submission requirements • Strong working knowledge of UB-04 and 837I requirements, revenue codes, bill types, condition and occurrence codes, modifiers, claim frequency codes, and payer-specific edits • Demonstrated ability to identify root causes, lead cross-functional teams through performance improvement initiatives, and sustain results while working with a high degree of independence • Ability to analyze billing, edit, hold, and rejection data to identify trends and quantify financial impact • Experience researching claim-generation issues in Epic Resolute or a comparable patient accounting system preferred • Experience using clearinghouse tools, payer portals, claim scrubbers, and reporting tools preferred • Exposure to multiple hospitals, facilities, or payer environments preferred • Proficiency in Microsoft Office Suite • Strong interpersonal and influencing skills, with the ability to communicate and present findings at all levels of the organization, including executive leadership • Strong problem solving and creative skills and the ability to exercise independent judgment and make decisions based on accurate and timely analyses • High level of integrity and dependability with a strong sense of urgency and results oriented • Excellent written and verbal communication skills required • Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes • Ability to work outside normal business hours for special projects • Occasional travel to client facility sites may be required

🏖️ Benefits

• Occasional travel to client facility sites may be required • Ability to work outside of normal business hours to support special projects • Smart-phone or electronic device capable of downloading applications provided/required for multifactor authentication and security purposes

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