Description
Are you passionate about transforming data into actionable insights and driving software solutions forward?
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, using the telephone, exposure to computer monitor screens, and repetitive data entry.
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