Responsible for analyzing denials, trends, and process inefficiencies to develop actionable improvement plans. Ensure accurate billing and coding by reviewing charge queues, collaborating with care centers, and resolving claim discrepancies. Works closely with internal and external teams to address escalated claim issues, maintain compliance with payer policies, and support process enhancements to maximize reimbursement. Principal Accountabilities: + Analyze trends in medical claim denials, reimbursement issues, and process-related challenges; translate findings into actionable improvement plans and projects. + Assist with charge work queues for proper billing and coding, ensuring accurate charges are released to the billing company as needed. + Collaborate with providers and practices to resolve claim discrepancies and initiate necessary corrections. + Research and resolve claims not paid within industry standards, ensuring compliance with prompt payment regulations. + Review and correct provider-related issues in the database, ensuring accurate information for claims processing. + Engage with practices and billing vendor to review claims in the Request for Information (RFI) portal for refiling accuracy as needed. + Review the Data Capture report for missing information or errors before claim submission, ensuring accuracy and coding compliance by cross-checking electronic medical record sources. + Work closely and collaborate with internal teams (e.g., Coding & Compliance, Credentialing, Managed Care Contracting) and external teams (e.g., Billing Vendor, Insurance Payer Representatives) to resolve escalated claim-related issues. + Review and verify accuracy of proposed guarantor and insurance refunds, collaborating with the billing vendor to resolve discrepancies and communicate approved refunds to Accounts Payable and Finance teams. + Participate in weekly meetings with Billing teams to identify process issues and recommend improvements. + Research and interpret insurance carrier billing or reimbursement policies to ensure compliance. + Maintain payer portal attestations for the PCP organization, ensuring timely compliance every 90 days. + Perform other duties as needed to support departmental and organizational goals. Required: + High School Diploma, or GED equivalent + Medical Coding Certificate (CPC or AHIMA) + 3-5 years of professional/physician revenue cycle experience (coding and billing processes) + 1-3 years of customer interfacing experience + 1-3 years MS Excel (Advanced) knowledge + Knowledge of medical terminology, ICD-10, HCPCS and CPT coding + Knowledge of healthcare administration; specifically, governmental and commercial insurance billing and reimbursement policies, procedures, and processes (ICD-10, HCPCS, CPT coding) Preferred: + Bachelor's Degree + Experience working in a Health Care facility, Hospital System or relevant area. ABOUT US At Atlantic Health System, our promise to our communities is; Anyone who enters one of our facilities, will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 20,000 team members. Headquartered in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation. Our facilities and sites of care include: + Morristown Medical Center, Morristown, NJ + Overlook Medical Center, Summit, NJ + Newton Medical Center, Newton, NJ + Chilton Medical Center, Pompton Plains, NJ + Hackettstown Medical Center, Hackettstown, NJ + Goryeb Children's Hospital, Morristown, NJ + CentraState Healthcare System, Freehold, NJ + Atlantic Home Care and Hospice + Atlantic Mobile Health + Atlantic Rehabilitation We also have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group. Atlantic Accountable Care Organization is one of the largest ACOs in the nation, and we are a member of AllSpire Health Partners. We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades: + 100 Best Companies to Work For ® and FORTUNE® magazine for 15 years + Best Places to Work in Healthcare - Modern Healthcare + 150 Top Places to work in Healthcare - Becker's Healthcare + 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 - AARP + Gold-Level "Well Workplace": Wellness Council of America (WELCOA) + One of the 100 Best Workplaces for “Millennials” Great Place to Work® and FORTUNE® magazine + One of the 20 Best Workplaces in Health Care: Great Place to Work® and FORTUNE® magazine + Official Health Care Partner of the New York Jets + NJ Sustainable Business EEO STATEMENT Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.