Healthcare Billing & Coding Research Analyst

Alpha II seeks a skilled Healthcare Billing & Coding Research Analyst to join our dynamic team! In this role, you will be instrumental in the growth and maintenance of our software solutions by researching industry trends, analyzing data sets, and identifying opportunities for enhancement. Your role will involve quantitative and qualitative analysis, a process-oriented mindset, and collaborative teamwork. 

Ideal candidates will bring at least 3 years of hands-on experience in Healthcare Billing and Coding or AR Recovery, demonstrating strong technical skills and a deep understanding of the healthcare and health insurance sectors. 

If you excel at interpreting complex technical information and defining business requirements, we invite you to contribute your expertise and help us innovate in a fast-paced environment.

Responsibilities:

• Work closely with Operations team members, inter-departmental teams, clients, and managerial staff

• Evaluate business processes, anticipate requirements, uncover areas for improvement, and develop and implement optimization strategies

• Stay up to date on the latest processes and medical billing guidelines to identify claim editing, fee schedule, and systematic changes for implementation

• Perform requirements analysis

• Document and communicate research results

• Conduct meetings and presentations to share ideas and findings

• Effectively communicate insights and plans to cross-functional team members and management

• Gather critical information from meetings with various stakeholders and create useful reports

• Ensure solutions meet business needs and requirements

• Perform system integration and user acceptance testing

• Assist with inquiries and audit requests from Customer Support related to billing/ coding edits and fee schedule logic.

• Manage projects, develop project plans, and monitor performance

• Manage competing resources and priorities

• Prioritize initiatives based on business needs and requirements

• Monitor deliverables and ensure timely completion of projects

• Update, implement, and maintain procedures

• Serve as a liaison between various stakeholders

• Other duties as required

Minimum Qualifications:

• A bachelor’s degree or higher in business, healthcare administration, information systems, computer science, finance, accounting, mathematics, or a related field of study

• 2+ years of experience in business analysis or a related field. Additional experience, industry knowledge, and certifications may substitute for educational requirements

• 3+ years of hands-on experience with either Healthcare Coding/Billing or AR Recovery (denials, collections, zero-balance review)

• Advanced Technical Skills:

• Excellent documentation skills

• Experience with requirements gathering and specification documentation

• Experience performing gap analysis, issue analysis, root cause assessment, and resolution planning

• Experience creating detailed reports and giving presentations

• The ability to influence stakeholders and work closely with them to determine acceptable solutions

• Competency in Microsoft applications, including Word, Excel, and Outlook

Preferred Qualifications:

• Experience preparing use case testing scenarios

• Experience performing and documenting system integration testing and user acceptance testing

• Experience with crosswalk development and maintenance

• Understanding of both professional and institutional claims processing and adjudication

• Knowledge of NUCC 1500 professional claim form and corresponding ASC X12N 837P electronic standard

• Knowledge of NUBC UB-04/CMS-1450 institutional claim form and corresponding ASC X12N 837I electronic standard

• Familiarity with CMS claims processing manual and publications.

Physical requirements:

Standing, sitting, kneeling, stooping, lifting, bending, climbing, twisting upper body, walking, pushing, pulling, occasional lifting and carrying of large boxes up to 25 lbs., listening, talking, use of telephone, exposure to computer monitor screens and repetitive data entry.