Revenue Analyst job - athenahealth - Belfast, ME

Position Overview:

Claim Resolution employees are responsible for the research and appropriate resolution of previously submitted medical claims. These claims have either been denied by the payer(s) or their benefit determination/adjudication is unknown. Claim Resolution is organized into four focused zones; Claim & Remittance Tracking, Denial Management, Appeals, and Workers’ Compensation. Each of the zones is staffed by Revenue Analysts who focus their efforts upon the timely and appropriate resolution of their designated claims, on behalf of athenahealth’s clients.

The Revenue Analyst is responsible for researching and resolving unpaid or denied claims. This is achieved primarily through working a queue of claims in line with specified turn-around-times, and in compliance with department policies and processes. These resolution efforts consist of (1) outbound phone calls and/or (2) using on-line data, to drive analysis and gather information that will prompt accurate claim processing. The Revenue Analyst also aggregates data and monitors activity for trends that can be used to identify opportunities to prevent future unpaid or denied claims.

Responsibilities:

• Resolve outstanding medical claims, including those which have been denied and those for which status is unknown


• Complete all work within specified turn-around-time frames, while meeting quality standards and production targets


• Become an expert and trusted client advisor for assigned payer(s) and/or national region(s)


• Timely resolution and response to all Client facing inquires via Sugar tasks/cases


• Commitment to achieving mastery of the role, minimum expectation of 12 months


• Conduct payer research and contact payers, directly by phone, to resolve unknown status and/or denied claims, in real time


• Enhance athenahealth’s payer relationships


• Resubmit claims in accordance with payer guidelines


• Identify payer adjudication trends Identify opportunities to enhance athena health’s library of payer adjudication Rules through either new Rule creation or refinement of existing Rules


• Conduct accounts receivable analysis, as needed


• Accept full ownership of special work and/or project assignments


• Fully participate in the drive to accomplish all department and corporate goals


• Become an engaged, and active participant in athena health’s teaching and learning culture
  

Qualifications:

• An ideal candidate will have medical billing/US healthcare experience or have demonstrated the ability to rapidly learn the foundational concepts of US healthcare and medical billing


• All candidates must possess a strong desire to learn, as well as embrace athenahealth’s unique problem-solving and creative-solutions based approach to our work while adhering to our Corporate Compliance Code


• Applicants should be excited by the prospect of working in a dynamic environment of continual change/improvement, driven by our rapid rate of growth


• As such, qualified candidates must possess strong analytical, communication, and organizational skills, and be detail oriented, in order to provide on-going support in the claim resolution process


• Bachelor’s degree or equivalent experience


• Research skills; via phone, web, payer manuals, etc.


• Ability to observe trends and recommend process improvements


• Proven and effective telephone and written communication skills

Compensation & Benefits: This position will earn an hourly wage, plus a potential bonus driven by individual, department and company success. Benefits for full-time employees include paid vacation and sick leave, paid holidays, health insurance, disability and voluntary participation in the Company’s 401k plan (including company match), and life insurance plan.

athenahealth, Inc. is a leading provider of web-based business services for medical groups. athenahealth’s service offerings are based on proprietary web-native practice management and electronic health record (EHR) software, a continuously updated payer knowledge-base, integrated back-office service operations, and automated and live patient communication services.