Global Rules Billing Associate

athenahealth; Boston (MA); On-site; USD 63,000 - 107,000; Full time

Benefits offered by this job

Commuter support

Employee assistance programs

Tuition assistance

Collaborative workspaces

Flexible work-life balance

Job summary

A healthcare technology company in Boston seeks a Global Rules Associate responsible for transforming client and payer requirements into billing logic. Candidates should possess strong analytical skills, a degree or relevant experience in insurance or medical coding, and exceptional communication skills. The role involves researching billing logic and collaborating with internal teams to optimize performance. Expected annual compensation ranges from $63,000 to $107,000, reflecting experience and skills. This position offers opportunities to improve processes in a dynamic environment.

Qualifications

• Bachelor's degree or relevant experience in an insurance or medical coding field.
• Experience solving complex healthcare billing issues.
• Comfortable with payer calls and direct client engagement.

Responsibilities

• Identify and transform client requirements into billing logic.
• Research and test claim billing logic.
• Collaborate with stakeholders to improve billing outcomes.

Skills

Analytical thinking

Communication skills

Problem solving

Data analysis

Attention to detail

Education

Bachelor’s degree or 3-5 years experience in insurance or medical coding

Tools

Cloud-based SaaS platforms

Job description

Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

Position Summary

The Global Rules Associate will be responsible for identifying and transforming client and payer requirements into business logic our development team will utilize to create and maintain industry leading billing rules that generate superior results. Requirements may be identified through client requests, internal insights, or data trends.

This individual has a combination of strong solution design skills, technical facility, analytical thinking skills, intense curiosity, and thrives on optimizing product and processes to maximize client value and operational efficiency. This individual should have experience with revenue cycle, claim formatting, and billing requirements. The Associate should demonstrate excellent communication skills, be detail oriented, understand how to manipulate and utilize large data sets, have a keen ability for solving business problems via independent analysis, and enjoy managing simultaneous projects with competing priorities and multiple stakeholders.

About The Team

The Global Rules Optimization (GRO) team empowers athenahealth to deliver industry-leading clean claim performance by implementing, influencing, and guiding upstream interventions that ensure the submission of clean claims with minimal work.

Analysis, Solution Design, and Project Management

• Research, design, and test claim billing logic to prevent claim rejections, denials, and billing work
• Grow and maintain athena’s library of insurance billing rules to minimize disruption to clients and internal teams
• Evaluate, prioritize, and act upon insights from clients, internal teams, and data to improve client and operational outcomes
• Management of and execution against problems of limited to moderate scope to research and improve specific areas of poor billing performance or drive process improvement
• Work effectively with stakeholders within and external to the GRO team to share billing expertise and collaborate on finding solutions to client needs.
• Analyze complex data sets, identifying trends and proactively developing solutions to globally felt customer issues

Education & Experience Required

• Bachelor’s degree or 3-5 years of experience in an insurance or medical coding field
• Experience solving complex healthcare billing problems involving revenue cycle, claim formatting, and coding requirements
• Certified Professional Coder (CPC) certification is a plus
• Comfortable initiating payer calls and engaging directly with clients and internal athena stakeholders via phone to troubleshoot, clarify requirements, and provide exceptional service.
• Comfortable navigating and utilizing web and software applications, with a foundational understanding of cloud-based SaaS platforms and emerging AI technologies to enhance efficiency and innovation

Expected Education & Experience

• Ability to assess large amounts of information, identify trends, and break information into key components
• Capable of transforming business requirements into logic statements
• Must be highly motivated and able to work independently as well as part of an extended, cross-functional team
• Understanding of the process of medical billing and medical terminology
• Excellent verbal and written communication skills
• Passion for customer service, problem solving, and solution design
• Ability to prioritize and to multi-task in a fast-paced environment, manage competing priorities and communicate potential conflicts to manager
• Capable of managing simultaneous projects with multiple stakeholders
• Maintain a curiosity on how things work and a willingness to dive deeper

Expected Compensation

$63,000 - $107,000

The base salary range shown reflects the full range for this role from minimum to maximum. At athenahealth, base pay depends on multiple factors, including job-related experience, relevant knowledge and skills, how your qualifications compare to others in similar roles, and geographical market rates. Base pay is only one part of our competitive Total Rewards package - depending on role eligibility, we offer both short and long-term incentives by way of an annual discretionary bonus plan, variable compensation plan, and equity plans.

About Athenahealth

Our vision:

In an industry that becomes more complex by the day, we stand for simplicity. We offer IT solutions and expert services that eliminate the daily hurdles preventing healthcare providers from focusing entirely on their patients — powered by our vision to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

Our company culture:

Our talented employees — or athenistas, as we call ourselves — spark the innovation and passion needed to accomplish our vision. We are a diverse group of dreamers and do-ers with unique knowledge, expertise, backgrounds, and perspectives. We unite as mission-driven problem-solvers with a deep desire to achieve our vision and make our time here count. Our award-winning culture is built around shared values of inclusiveness, accountability, and support.

Our DEI commitment:

Our vision of accessible, high-quality, and sustainable healthcare for all requires addressing the inequities that stand in the way. That's one reason we prioritize diversity, equity, and inclusion in every aspect of our business, from attracting and sustaining a diverse workforce to maintaining an inclusive environment for athenistas, our partners, customers and the communities where we work and serve.

What We Can Do For You

Along with health and financial benefits, athenistas enjoy perks specific to each location, including commuter support, employee assistance programs, tuition assistance, employee resource groups, and collaborative workspaces — some offices even welcome dogs.

We also encourage a better work-life balance for athenistas with our flexibility. While we know in-office collaboration is critical to our vision, we recognize that not all work needs to be done within an office environment, full-time. With consistent communication and digital collaboration tools, athenahealth enables employees to find a balance that feels fulfilling and productive for each individual situation.

In addition to our traditional benefits and perks, we sponsor events throughout the year, including book clubs, external speakers, and hackathons. We provide athenistas with a company culture based on learning, the support of an engaged team, and an inclusive environment where all employees are valued.

Learn more about our culture and benefits here: athenahealth.com/careers

https://www.athenahealth.com/careers/equal-opportunity