Senior Billing Analyst
1 week ago
The core function of this role is to review and research all claims for accuracy prior to submission to third-party payers. Within compliance guidelines, the Senior Billing Analyst updates claims and works with the necessary departments to minimize denials, pricing discrepancies, charge issues, patient registration, and financial clearance information concerns to submit correct claims to guarantors and payors and follow up on balances.
Key Responsibilities- Responsible for high balance insurance billing, specialized insurance billing, and respective edit resolution.
- Prepares insurance claims for submission to all third-party payers and/or responsible parties. Ensures all errors are corrected.
- Prepares self-pay bills in a timely manner, follows up on balances, and resolves patient queries.
- Reviews claims for accuracy, including proper diagnosis and procedure codes.
- Ensures appropriate review of bills and statements before sending out to insurance companies to reduce risks of denial.
- Assists with the implementation or upgrade of the billing system.
- Ensures compliance of billing in accordance with the CCAD and UAE insurance regulations.
- Recognizes and resolves billing or coding inconsistencies. Uses clinical and coding knowledge to ensure accurate and compliant charge items.
- Adheres to Patient First value.
- Productivity target: Minimum of 100 unique accounts per working hours.
- Initial Denial Rate: Denial less than 10%.
- Timely Submission, follow-ups, and payment recovery: Minimum of 85% claims/bills completed and submitted within 24 hours.
- Patients/Guarantor Customer Services: Timely response to patients/payors emails/queries, prevent abandoned calls, manage and mitigate patients/payor complaints.
- Bachelor's degree is required. In the absence of a Bachelor's Degree mentioned above, an equivalent experience of four (4) years working in the same capacity in a hospital, clinic, or health insurance company involved in provider/patient contacts will be considered.
- Minimum of 2 - 3 years' billing experience is required, preferably in-patient accounting billing system or healthcare insurance company.
- Knowledge and understanding of patient accounts management, including insurance processing and cash application.
- Proficient with PCs, spreadsheets, and other software applications.
- Strong oral and written communication skills.
- Ability to speak and write in English is required.
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