Insurance Compliance Analyst jobs in Spartanburg, SC

Position Summary

The Billing Compliance Analyst reports directly to the Billing Manager while working closely with other Business Services Management (Director, Manager, and Supervisors, etc.).

Minimum Requirements

Education           

• Bachelor’s Degree or 5-7 years of demonstrated work experience with electronic billing files.

Experience        

• Minimum of 3-5 years’ experience with current utilized Revenue Cycle Systems (i.e., McKesson STAR, RelayHealth EPremis, etc)
• Must be proficient in billing of UB and 1500 electronic claims and edits.
• Microsoft Office Suite

License/Registration/Certifications       

• N/A

Preferred Requirements

Preferred Education      

• Bachelor’s degree in Computer Science or 7 years’ experience in similar role/similar systems

Preferred Experience   

• Minimum of 5 years’ experience with currently utilized Revenue Cycle Systems

Preferred License/Registration/Certifications   

• N/A

Core Job Responsibilities

• Responsible for effective implementation, operations, updates, and maintenance of all Hospital Claims/EDI electronic billing systems utilized at Spartanburg Regional Healthcare System.
• Responsible for billing/EDI system integration changes/update reviews.  Within this responsibility, is to evaluate the update/request processes to determine feasibility, scope and resource needs to successfully implement new products/systems/procedures/system configurations.  Report all findings and recommendations to management.  
• Develop and provide education of system functionality, upgrade improvements and limitations to a wide variety of both new and current system users, and the continued improvement in both the functionality and effectiveness of the electronic billing systems. 
• This position works closely with the Financial Applications Specialist and the Information Services-Revenue Cycle Systems Analysts on all changes and/or updates to Hospital Information Systems that directly affect the billing team. In this role, the Billing Compliance Specialist coordinates the activities and interactions required for selection, implementation, upgrades, and maintenance of hospital information system/electronic billing systems with IS-Systems Analysts.  
• This position is required to demonstrate proficiency in STAR Billing, including systems integration and data systems maintenance requirements (tables and control files). This position will be responsible for education of business service teams when new procedures are implemented. 
• The ability to effectively plan and develop timely and efficient work processes when system upgrades or changes are needed. The ability to effectively serve as a project lead, engage stakeholders in necessary work functions, and produce tangible results in improved system functionality and the ability to meet business needs is critical to the success of this position.
• The ability to function as a historian of changes to the billing system is critical with organized documentation as to the reason for the changes. Documentation of testing and live system results to “prove” functional and regulatory changes have been made and are functioning properly. 
• Monitors Recon Manager and Gatekeeper to address issues with electronic claims and/or files.
• Works with business services and other department to deploy bridge routines to promote “clean claims the first time and every time.”
• Reviews governmental and commercial electronic billing requirements to assure compliance.
• Function as the point person with electronic claim vendor to monitor open service orders, provides progress reports, and updates to manager.