Billing & Rejections Analyst

The BR Analyst is responsible for accurate and timely processing of healthcare claims, identifying and resolving rejected or denied claims, and ensuring compliance with billing standards. This role involves monitoring billing queues, performing edits, analyzing rejection patterns, and collaborating with internal and external teams to optimize revenue cycle performance. The Analyst will play a key role in minimizing financial leakage, maintaining billing accuracy, and supporting operational efficiency.

Essential Functions:

In addition to working as prescribed in our Performance Factors specific responsibilities of this role include:

• Process claims in Customer Service (CS) queues, perform edits, and manage unbilled items to ensure timely submission.
• Review and analyze rejected or denied claims, identify root causes, and implement corrective actions.
• Maintain clear and accurate documentation of billing activities, including system notes and audit trails.
• Collaborate with internal teams and payers to resolve billing issues efficiently.
• Monitor trends in claim rejections and provide feedback for process improvements.
• Ensure compliance with all billing, reimbursement, and regulatory requirements (including HIPAA).
• Meet or exceed daily/weekly productivity and quality targets.

All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA, and other applicable regulations.

Key Result Areas (KRAs):

• Production: Target ≥ 100%, Weightage 40%. Regular CS queues, edits, unbilled items.
• Quality: Target ≥ 98.5%, Weightage 40%. Achieve your set target on a monthly basis.
• Follow SOPs and Checklists: Target ≥ 95%, Weightage 10%. Follow SOPs, Site Books, and Checklists.
• Time on System: Target 9 hrs daily, Weightage 4%. Meet required 9 hrs time-on-system mandate (only 3 days non-adherence allowed).
• Shift Adherence: Target Login before shift time, Weightage 3%. Meet required shift start/end mandate (only 2 days non-adherence allowed).
• Unapproved Leaves: Target 0, Weightage 3%. Associate should not take any unapproved leaves.

Minimum Requirements:

• Bachelor's degree (preferred) or equivalent experience in healthcare administration, finance or related field.
• 2 - 4 years of experience in U.S. healthcare billing, claim processing, or denial management.
• Strong written and verbal communication skills.
• Working knowledge of medical terminology, ICD-10, CPT, and HCPCS codes.
• Basic computer proficiency.
• Willingness to work continuous night shifts.

Experience / Certification:

• Prior experience in U.S. healthcare BPO/RCM preferred.
• Familiarity with billing software, EHR systems, or clearinghouses such as Waystar, Realmed, Availity, Change Healthcare, and ViaTrack.
• Proficiency in MS Excel, MS Word, and Google Sheets preferred.

Skills & Technical Proficiency:

• Strong analytical and problem-solving skills with attention to detail.
• Ability to identify, analyze, and resolve rejected claims efficiently.
• Ability to manage multiple tasks while processing high volumes of claims accurately.
• Strong organizational and time management skills.
• Ability to work independently with minimal supervision.
• Commitment to maintaining confidentiality and compliance with HIPAA.

Working Environment/Physical Demands:

Working Environment:

• General office environment: Works generally at a desk in a well-lighted, air-conditioned office, with moderate noise levels.
• Periods of stress may occur.
• May require collaboration across teams (Coding, AR, payment posting).

Physical Demands:

• Activities require a significant amount of sitting at office and work desks and in front of a computer monitor.
• Some walking and standing relative to interaction with other personnel.

Travel Requirements:

None (25% or Less), Occasional (25% - 40%), Moderate (40% - 80%), Frequent (80% or more), Very Frequent.

Other possible Unofficial Titles:

Unofficial titles may be given by the manager and used for email signature.

Note: Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This document does not create an employment contract, implied or otherwise. It does not alter the "at will" employment relationship between the company and the employee.

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