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Billing Rules Operations Associate

Position Summary: 
Athenahealth’s Billing Rules Engine is the repository for all business logic (billing rules) that tells the system when and how claims should be formatted based on insurance policies, medical information, and regulations. The Billing Rules Operations Associate is a critical thinker who is responsible for managing client cases through understanding client and industry requirements for billing rules, claim formatting, and defining additions or updates to athena’s billing rules engine.  The Associate will work to become an expert in healthcare insurance claim formatting and in athena’s billing rules engine though team engagement, formal and informal trainings, and proactively seeking to fill knowledge gaps.  The position requires analytical thinking, superior attention to detail, effective communication skills, the ability to balance multiple issues at once, and shift focus as needed.

Essential Functions (Duties and Responsibilities): 

Manage client cases (20%)

• Communicate clearly through written and verbal updates with clients and internal stakeholders
• Communicate complex issues or scenarios in a clear and concise manner 
• Complete required steps to document case details for reporting purposes
• Manage/monitor about 25 cases at a time, each in a different stage   
• Prioritize own work across several task management systems daily 
• Provide timely updates and resolutions
• Manage escalations across clients as needed, knowing when to bring leadership in for support
• Research, design, and test claim billing logic to prevent claim rejections, denials, and billing work

Define Business Requirements and Technical Solutions (60%)

• Become a subject matter expert in one or more types of healthcare claim submission and billing logic  
• Use your knowledge of healthcare billing, athenaOne, and billing rules to troubleshoot client issues and determine 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 judgement to determine whether client requests should be implemented in the billing rules engine.  Identify and clearly communicate alternative solutions when billing rules are not the best solution for the client’s request.
• Collaborate with colleagues, including developers, to create high-quality billing rules engine updates that meet client needs and payer guidelines 
• Design quality solutions by synthesizing large amounts of complex information into clear logic statements
• Define and execute test plans to validate that technical solutions meet client needs

Be an active participant in athena’s teaching and learning culture (20%)

• Proactively identify gaps in knowledge and seek out opportunities to fill those knowledge gaps
• Identify opportunities for process improvement.  Provide feedback to management
• 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: 

• College Degree or 3-5 years of relevant experience
• Experience working in a corporate setting populated by diverse backgrounds
• Familiarity and comfort around web/software applications and a basic understanding of cloud-based SaaS
• Interest in solving complex Healthcare billing problems
• Certified Professional Coder certification is a plus

Knowledge & Skills: 

• Demonstrates analytical thinking: 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