Onsite role
Job Description
High Level Summary
The Medical Billing and Collections Analyst reports to the Manager of Billing and Administration and supports Biologics by Clients. This individual contributor is responsible for accurately and timely processing medically billed claims, researching and resolving claim denials and unpaid balances, supporting collection activities, and completing related invoicing and administrative transactions. The Analyst works closely with Operations, Payer Access, Cash Applications, Account Management, Compliance, and Finance to improve billing accuracy, accelerate reimbursement, maintain effective controls, and support the revenue cycle across Oncology, Rare & Orphan, and Cell & Gene product lines.
Key Responsibilities:
Prepare, review, and submit medically billed claims through CareTend and WayStar in accordance with payer requirements and established procedures.
Verify patient, insurance, authorization, coding, and supporting documentation information before claim submission; correct identified errors promptly.
Monitor claim status, aging, denials, rejections, and underpayments; research root causes and complete timely follow-up, correction, resubmission, reconsideration, or appeal activities.
Contact payers, patients, and internal partners as appropriate to resolve outstanding balances and document all collection activity accurately.
Support manufacturer chargeback activities by preparing invoices, submitting required documentation, monitoring payment status, and resolving discrepancies.
Process billing and invoicing transactions associated with the Exelan VA Lenalidomide program and other assigned programs.
Reconcile claim, remittance, payment, adjustment, and account information across applicable systems; escalate variances that cannot be resolved within established guidelines.
Maintain complete and accurate account notes, work queues, appeal records, payer correspondence, and supporting documentation.
Complete assigned administrative functions, including patient statement distribution, incoming mail review, and routing checks or other payments to the designated lockbox process.
Follow internal controls, policies, standard operating procedures, payer requirements, privacy standards, and compliance expectations.
Track productivity, quality, denial, collection, and aging metrics; prepare recurring reports and communicate emerging trends or barriers to the Manager of Billing and Administration.
Identify recurring billing or collection issues and recommend practical process improvements that increase accuracy, efficiency, and reimbursement.
Provide responsive, customer-focused service while collaborating with patients, payers, manufacturers, Operations, Payer Access, Cash Applications, Account Management, Compliance, Finance, and other support teams.
Support additional Accounts Receivable, billing, collection, and special-project activities as business needs evolve.
Competencies and Best Practices for High Performers
Demonstrates a customer-centric approach and communicates professionally with patients, payers, manufacturers, and internal partners.
Exercises sound judgment, attention to detail, and ownership when researching and resolving billing and collection issues.
Works effectively across functions and levels of the organization to obtain information, remove barriers, and achieve timely resolution.
Manages multiple priorities, deadlines, work queues, and follow-up commitments in a fast-paced environment.
Communicates clearly in writing and verbally, including concise documentation of account activity and escalation of risks.
Adapts to changing payer rules, systems, procedures, priorities, and business requirements.
Additional Knowledge and Skills
Working knowledge of medical billing, claim submission, payer follow-up, denial resolution, appeals, reimbursement methods, patient collections, and accounts receivable principles.
Experience with CPR+, CareTend, WayStar, SAP, payer portals, or comparable pharmacy, billing, and enterprise systems is preferred.
Ability to interpret explanations of benefits, remittance advice, denial codes, payer policies, account histories, and supporting documentation.
Strong analytical and problem-solving skills, including proficiency with Excel spreadsheets, data validation, reconciliations, and trend analysis.
Ability to maintain confidentiality and handle protected health information and financial information in accordance with applicable requirements.
Minimum Requirements
3+ years of medical billing, healthcare collections, claims follow-up, denial management, or related accounts receivable experience in a high-volume environment.
High school diploma or equivalent required; associate or bachelor's degree in business, finance, accounting, healthcare administration, or a related field preferred.
Experience working with commercial, government, or other healthcare payers and resolving denied, rejected, or unpaid claims.
Knowledge of specialty pharmacy, oncology, rare disease, or cell and gene therapy reimbursement is preferred.
Work Schedule: M-F 7am-4pm
Is this Remote/Hybrid/Onsite?: Hybrid (Remote with one day onsite)
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