Billing Analyst I

To efficiently and accurately audit bills according to standard Broadspire, State and/or National legislative and fee guidelines.


* A high school diploma or equivalent experience is required.


* 2 or more years work experience with CPT and ICD-9 codes or classroom experience is required.


* ility to problem solve, analyze, organize and prioritize work.

Strong reading comprehension, verbal and written communication skills required with Windows environment experience.

Must be able to produce a high volume of quality work, be organized, multi-tasked, and prioritize work.

Familiar with HFCA and UB92 forms is required.

#LI-RG1


* Review and verify diagnosis codes, provider information, payer information, procedure codes and dates of service.


* Identify bills requiring research and assign bill notes and/or explanation codes indicating the reason for additional research.

Apply bill/form type, modifiers and units when necessary.

Process duplicate bills according to standard procedures.


* Enter bill information manually when required, calculating appropriate payment recommendation if necessary.

Transfer bills that meet specific criteria; (i.e., surgical, ambulatory, etc).

May consult with internal medical professionals to receive support for bill decisions to reduce legal exposure.


* Review and interpret relevant medical information including medical records, treatment reports, operative reports, consultation reports, diagnostic evaluations and functional capacity evaluations to accurately determine adjudication.


* Verify fee schedule and usual and customary rules according to state law or national guidelines.

Apply advanced and/or proprietary reimbursement methodologies when appropriate.


* Communicate with providers, trainers and peers verbally and in written form.


* Meet required Quality/Production Standards while maintaining turnaround on assigned states.

Ensure accurate and efficient processing; accurately report bills processed daily.


* May perform other duties as assigned.