Billing Analyst
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Job Description
Billing Analyst ensuring accurate billing operations and compliance across healthcare services at Pacific Health Group. Collaborating with cross-functional teams for efficient revenue cycle management, meeting deadlines effectively.
Responsibilities:
- Collaborate with case managers, social workers, and patient coordinators to ensure accurate and complete documentation of care plans, services rendered, and changes in patient condition or level of care.
- Maintain detailed, organized billing records that support compliance and accuracy.
- Prepare, review, and issue accurate and timely invoices and claims to Medicaid and other payers.
- Assign appropriate medical codes for diagnoses, treatments, and services in long-term care and healthcare settings.
- Ensure all claims comply with payer-specific guidelines and documentation requirements.
- Manage multiple billing accounts simultaneously while meeting strict deadlines.
- Ensure compliance with consolidated billing requirements for health plans.
- Review EOPs/EOBs (Explanation of Payments/Benefits) to identify and resolve unpaid or denied claims.
- Investigate reasons for claim rejections, prepare appeals, and resubmit claims as necessary.
- Track denial trends and collaborate with internal teams to improve accuracy and reduce future occurrences.
- Monitor accounts receivable and follow up with payers and health plans to resolve outstanding balances or discrepancies.
- Reconcile payer reimbursements with submitted claims to ensure accuracy and completeness of financial records.
- Prepare financial summaries and assist with monthly revenue cycle reports.
- Stay current on changes in billing regulations, long-term care reimbursement policies, and coding guidelines to maintain compliance and support process improvement.
- Adhere to all Medicaid, managed care, and federal billing regulations.
- Provide support and guidance to staff on documentation, billing, and coding best practices to ensure consistent, compliant submissions.
- Perform other related billing, reporting, and administrative duties as assigned by management.
Requirements:
- Minimum 2+ years of experience in medical billing or healthcare revenue cycle operations, preferably in long-term care, managed care, or Medicaid environments.
- Over 2 years of experience reviewing and processing EOPs/EOBs.
- Proven ability to manage multiple priorities and deadlines with accuracy and efficiency.
- Strong understanding of ICD-10, CPT, and other medical coding systems.
- Familiarity with Medicaid, managed care, and healthcare reimbursement processes.
- Knowledge of consolidated billing and payer-specific guidelines.
- Proficiency in medical billing software, EHR systems, and standard office tools (Excel, Word, Outlook).
- Ability to analyze billing discrepancies, identify solutions, and maintain meticulous documentation.
- Exceptional attention to accuracy, organization, and compliance.
Benefits:
- 160 Hours of Paid Time Off (PTO)
- 12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
- 4 Paid Volunteer Hours per Month to support causes you care about
- Bereavement Leave, including Fur Baby Bereavement
- 90% Employer-paid Employee-Only Medical Benefits
- Flexible Spending Account (FSA)
- Short-Term & Long-Term Disability | AD&D
- Employee Assistance Program (EAP)
- 401(k) with Company Match
- Monthly Stipend
- Opportunities for professional development and internal growth
- Employee Discounts via Great Work Perks and Perks at Work
- Quarterly In-Person Events
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