The Billing analyst is responsible for monitoring and analyzing the accuracy and integrity of the various aspects of the billing/reimbursement process. Responsible for analyzing billing laws and contract regulations to ensure the most efficient billing of third-party payers by Springfield Clinic, and completing projects involving analysis of denials, billing errors, and reimbursement questions. Job Relationships Reports to the Billing Compliance Manager Principal Responsibilities Note: Following duties will be assigned at the direction of the Billing Compliance Manager; because of multiple staff at position all of the following duties may not be assigned to a specific staff member per the work plan of the Billing Compliance Unit. • Work on research projects as assigned towards proper reimbursement by third-party payers. • Analyze Medicare and Medicaid regulations and assist in education efforts for providers and staff towards compliance with these rules. • Analyze contractual insurance plans towards assurance that Springfield Clinic receives reimbursement as defined in various contracts and fee schedules. • Work on projects as assigned towards overall billing compliance with all laws and regulations. Perform Compliance Audit Reports as assigned with follow-up reporting to Patient Accounting Coding and Billing Oversight Committee and/or Springfield Clinic Compliance Committee. • Provider education projects and responsibilities as assigned. Could involve face-to-face meetings, educational memos, participation in orientation sessions, etc. • Assist in maintaining pre-submission claim editing systems and analysis projects resulting from reports of that system as assigned. • Analyze monthly insurance denial reports as assigned. • Serve as occasional backup, as needed, to other Billing Compliance Unit staff members • Comply with the Springfield Clinic incident reporting policy and procedures. • Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy. • Provide excellent customer service and adhere to SC Way customer service philosophy. • Other duties as assigned. Education/Experience • High School graduate or GED required; college preferred. • Minimum three (3) years of insurance billing/review work required. Knowledge, Skills and Abilities • Strong analytical and communication skills. • Proficiency using software applications to perform job duties. • Ability to work independently on assigned duties with minimal supervision. • Ability to further knowledge of laws and regulations by continuing education efforts (reading manuals/subscriptions/newsletters; attending in-services and educational conferences). • Manual dexterity required for use of calculator and computer keyboard. Working Environment • Working in high stress area that may involve handling angry customers. • Some amount of travel, typically locally required. • Requires sitting and standing for periods of time working in an office environment. PHI/Privacy Level HIPAA1