medical billing associate

Albany Med; United States; On-site; USD 46,000 - 60,000; Full time

Job summary

Albany Med Health System is seeking a Medical Billing Associate. This intermediate billing role focuses on follow-up on billed accounts needing rebill, payer responses within guidelines, and handling denials with supporting documentation.

The incumbent must learn quickly, work independently, and use payer portals to locate policies impacting timely payment.

Collaboration with coding and other departments is essential to resolve edits and denials, while meeting daily productivity and QA standards.

Responsibilities

• Resolve intricate billing edits on previously billed claims and understand initial denials to rebill successfully.
• Follow up on No Response WQs and communicate with payers via phone, email, or website platforms.
• Locate denial or remittance details on payer websites as needed.
• Respond to denials with possible re-billing or appeals supported by documentation.
• Collaborate with coding and other departments to resolve edits or denials and mitigate payer trends.

Job description

Department/Unit: Physicians Billing Work Shift: Day (United States of America) Salary Range: $46,215.00 - $60,080.00

Job Description Summary

The Medical Billing associate is an intermediate billing position within the Hospital or Physicians Billing Offices for the Albany Med Health System (AMHS). This role is centered around the timely follow up needed on accounts that have already been billed but need re-billing, accounts in which the payer has not responded within the regulatory guidelines, or AMHS has received a denial that needs an immediate action and/or rebuttal. The denials assigned in this role are more intricate than others and the denial response may require a professional narrative accompanied by supporting documentation to be overturned. Some or all these areas may be the focus of the position depending on the resources needed. The incumbent must be able to prove that they have an ability to learn quickly and work independently. They will possess the ability to use payer websites to locate payer policies that may be impacting the ability for AMHS to be paid timely. The incumbent will be expected to work independently and meet production standards after the prescribed onboarding and training is concluded. Communication with peers, trainers, and leaders will also be imperative to success.

Essential Duties and Responsibilities

• Resolve the more intricate billing edits as assigned. The edits are the result of claims that have previously billed and require an increased ability to understand what happened initially and the additional requirements that are needed to rebill successfully.
• Follow up on the No Response WQs as assigned. Communicate with the payer via phone, email, or website platforms as needed.
• Ability to locate denial or remittances via the payer websites as needed.
• Respond to denials received on accounts as assigned. This may require a re-billing of a claim after updating the correct information or it may require the submission of an appeal with supporting documentation.
• Collaborate professionally internally or with external departments when needed to resolve the edit or denial. This may require consistent communication with coding or individual departments. For those that have coding certifications, the collaboration with Coding will be complementary and beneficial to both areas.
• Identify and present the payer trends amongst the claims that are editing for similar reasons. Communicate and work with the leaders to mitigate.
• The expectation is that this role can work all billing edits and will serve as a resource to the Medical Billing Associate as needed.
• Identify payer trends within the denials and work with leaders to mitigate those denials where possible. The goal is to minimize the aging AR.
• Proper and detailed notation of actions taken on the account. Others will rely on those notes when taking the next step on the account follow up.
• Payer Website navigation as needed to obtain information.
• Review, understand, and locate payer policy guidelines as required.
• Ability to locate claim adjudication details with the supporting documentation.
• Proficient use of Epic, On Base, and other platforms as needed.
• Ability to work independently and under time constraints and deadlines and with minimal supervision.
• Able to prioritize workload in an effective manner.
• Begin to articulate possible avenues to resolve claim challenges.
• Meet daily/weekly productivity standards with acceptable QA results.
• Other duties as assigned.

Revenue Cycle Management

This position will identify accounts that need to be placed on the payer agendas as they are not being resolved through the normal dispute process. The accounts are aging on the accounts receivable. Concentration on the AR > 60 days. Identification and communication of payer trends that are negatively impacting the overall AR. Timely and professional communication with outside departments to resolve the billing or follow-up challenges. Consistent and responsive communication with Patient Access and Coding are a must. Identification of department trends that need to be brought to Management to address with the departments. Participate as needed and at the request of leadership. These could include practices, hospital departments, as well as departments within the revenue cycle. Build an understanding of expected reimbursement on the accounts to ensure correct payments are received. Build an understanding of the reports provided by leadership as it pertains to the assigned task or assignment.

Albany Med Health System is an equal opportunity employer. This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Albany Medical Center is the centerpiece of medicine, research, and medical education in New York’s Capital Region and is the area's largest private employer with more than 10,000 employees. Albany Medical Center offers excellent career opportunities in a wide range of roles in both patient care and administration. We value all our staff members and offer outstanding employee benefits including:

• Excellent health care coverage with no copay at Albany Medical Center providers
• A wide array of services and programs to support emotional, physical, and mental wellbeing

Anchored in the state’s historic capital city, Albany Medical Center offers a full range of inpatient and outpatient care and is home to the region’s largest hospital, only Level 1 adult and pediatric trauma centers, and only children’s hospital. The downtown campus also offers opportunities at Albany Medical College. Albany Medical Center, along with Columbia Memorial Health, Glens Falls Hospital, Saratoga Hospital, and the Visiting Nurses, form the Albany Med Health System, serving more than three million people over 25 counties.