Job description
Job Purpose
The Billing Optimization Analyst is an experienced hospital billing professional responsible for evaluating and resolving barriers that prevent accurate and timely claim submission. The analyst applies working knowledge of Medicare, Medicaid, managed care, and commercial payer requirements across the claim-generation lifecycle, including edits, claim splits, bill holds, rejections, late charges, and other exceptions. Working collaboratively with billing, operational, clinical, reimbursement, and technology teams, the analyst shares findings and practical recommendations that improve first-pass clean-claim performance, reduce DNFB, and accelerate revenue capture. Duties & Responsibilities
Support the hospital claim-generation lifecycle, from final coding and charge capture through claim creation, validation, and transmission
Research and resolve billing edits, claim splits, bill holds, rejections, late charges, stop bills, and other exceptions that delay claims from being released
Apply Medicare, Medicaid, managed care, and commercial payer billing requirements to support accurate and timely claim submission
Analyze recurring claim barriers and help identify root causes across processes, system configuration, payer rules, and upstream workflows
Collaborate with billing leaders and team members to review billing scenarios, share findings, and recommend practical resolution steps
Partner with operational, clinical, reimbursement, coding, IT, and vendor teams to support improvements to edits, work queues, workflows, and escalation processes
Monitor first-pass clean-claim rate, bill-hold days, DNFB, rejection trends, and billing throughput to identify improvement opportunities
Document billing scenarios, root causes, recommended actions, and reusable guidance to support team consistency
Qualifications
2–3 years of hospital billing experience, including hands-on experience resolving claims before submission
Working knowledge of the end-to-end institutional claim lifecycle, including claim edits, split-billing scenarios, bill holds, rejections, late charges, stop bills, and corrected or replacement claims
Knowledge of Medicare, Medicaid, managed care, and commercial payer billing rules, claim formats, and submission requirements
Familiarity with UB-04 and 837I requirements, revenue codes, bill types, condition and occurrence codes, modifiers, claim frequency codes, and payer-specific edits
Ability to research why a claim cannot be released, identify the appropriate resolution or escalation path, and clearly explain the next action to team members and stakeholders
Proficiency in Excel and comfort reviewing billing, edit, hold, and rejection data for trends
Clear written and verbal communication skills with a collaborative, consultative approach to problem-solving
Experience researching claim-generation issues in Epic Resolute or a comparable patient accounting system
Experience using clearinghouse tools, payer portals, claim scrubbers, and reporting tools
Exposure to multiple hospitals, facilities, or payer environments
Experience sharing billing guidance or helping team members work through claim issues
Applies hands-on billing knowledge to identify, investigate, and resolve claim edits, splits, holds, rejections, and submission barriers
Demonstrates working knowledge of Medicare, Medicaid, managed care, and commercial payer requirements and proactively seeks guidance when needed
Uses analytical thinking to evaluate billing data and claim-level details, identify patterns and root causes, and recommend practical next steps
Builds effective partnerships by listening, asking targeted questions, communicating findings clearly, and collaborating with stakeholders on solutions
Collaborates effectively with clinical, operational, financial, reimbursement, coding, and technology teams to support revenue cycle improvement initiatives
Takes ownership of assigned issues by driving resolution or appropriate escalation while maintaining accurate and complete documentation
Working Conditions
Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress
Work Environment: The noise level in the work environment is usually minimal
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.