Billing Rules Operations Associate

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

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

About Athenahealth

Our vision: In an industry that becomes more complex by the day, we stand for simplicity. We offer IT solutions and expert services that eliminate the daily hurdles preventing healthcare providers from focusing entirely on their patients — powered by our vision to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

Our company culture: Our talented  employees — or athenistas, as we call ourselves — spark the innovation and passion needed to accomplish our vision. We are a diverse group of dreamers and do-ers with unique knowledge, expertise, backgrounds, and perspectives. We unite as mission-driven problem-solvers with a deep desire to achieve our vision and make our time here count. Our award-winning culture is built around shared values of inclusiveness, accountability, and support.

Our DEI commitment: Our vision of accessible, high-quality, and sustainable healthcare for all requires addressing the inequities that stand in the way. That's one reason we prioritize diversity, equity, and inclusion in every aspect of our business, from attracting and sustaining a diverse workforce to maintaining an inclusive environment for athenistas, our partners, customers and the communities where we work and serve.

What we can do for you:

Along with health and financial benefits, athenistas enjoy perks specific to each location, including commuter support, employee assistance programs, tuition assistance, employee resource groups, and collaborative  workspaces  — some offices even welcome dogs.

We also encourage a better work-life balance for athenistas with our flexibility. While we know in-office collaboration is critical to our vision, we recognize that not all work needs to be done within an office environment, full-time. With consistent communication and digital collaboration tools, athenahealth enables employees to find a balance that feels fulfilling and productive for each individual situation.

In addition to our traditional benefits and perks, we sponsor events throughout the year, including book clubs, external speakers, and hackathons. We provide athenistas with a company culture based on learning, the support of an engaged team, and an inclusive environment where all employees are valued. 

Learn more about our culture and benefits here: athenahealth.com/careers  

https://www.athenahealth.com/careers/equal-opportunity