Billing Rules Associate

Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

he Billing Rules Associate is responsible for resolving client cases by understanding client and industry requirements for billing rules and claim formatting, and defining additions or updates to athena's billing rules engine. The Associate will become an expert in healthcare insurance claim formatting and athena's billing rules engines. The position requires analytical thinking, superior attention to detail, and strong communication skills.

Essential Functions (Duties and Responsibilities):

80% work, document, and resolve complex client cases

• Provide timely updates and resolution.

• Communicate clearly through written and verbal updates with clients and internal stakeholders. Communicate complex issues or scenarios clearly and concisely.

• Ability to prioritize and multi-task in a fast-paced environment, manage competing priorities and escalations with balanced decision-making.

• Become a subject matter expert in one or more types of healthcare claim submission and billing logic.

• Use your knowledge of healthcare billing, athenaNet, and billing rules to troubleshoot client issues and determine the root cause of the problem.

• Understand the context and business reason behind client requirements.

• Validate payer requirements using payer documentation and phone calls to payers.

• Use team guidelines and best practices, compliance requirements, and own judgment to determine whether client requests should be implemented in the billing rules engine.

• Document client and payer requirements using team standards.

• Synthesize large amounts of complex information into clear logic statements.

• Design solutions that meet quality goals.

• Collaborate with colleagues, including developers, to create high-quality billing rule engine updates that meet client needs and payer guidelines.

• Define and execute test plans to validate that technical solutions meet client needs.

20% Be an active participant in athena's Teach and Learn culture

• Seek out opportunities to grow your knowledge in assigned areas.

• Identify opportunities for process improvement.

• Participate in case retrospective reviews to learn from experiences.

• Support teammates by sharing your process and subject matter expertise.

• Participate in team-wide efforts to improve knowledge management and training.

Education & Experience Required:

• Bachelor's degree or equivalent

• 5-7 years of experience in a fast-paced environment

• Previous experience in healthcare RCM environment,mandatory

• Familiarity and comfort around web/software applications and a basic understanding of cloud-based SaaS

• Proficiency in Microsoft Office Suite: Excel, PowerPoint, Word, Outlook, OneNote

• Interest in solving complex Healthcare billing problems

Knowledge & Skills:

• Demonstrates analytical thinking: a systematic, logical approach to managing complex, high volumes and/or contradictory information

• Excellent organizational skills and strong attention to detail

• Manage multiple projects with competing priorities

• Clearly frame a problem statement, research, and troubleshoot

• Clearly communicate complex industry requirements to clients

• Anticipate and balance the needs of multiple stakeholders

• Comfortable learning new programs/tools/applications

• Ability to instruct others, especially peers and clients to explain process workflow concepts

• Proven ability to work both independently on projects and as part of a larger team

• Flexibility to take on new tasks and challenges