Billing Analyst

Department: UHC: Psychiatry - Clinical

Job Summary: Manages outpatient and inpatient billing work queues daily to ensure charges are reviewed, processed, and submitted accurately and within established timelines. Creates and maintains guarantor accounts and applies the appropriate carve-out insurance coverage based on the location and type of services rendered. Utilizes comprehensive knowledge of ICD-10 diagnosis codes, CPT procedure codes, and payer-specific billing requirements to ensure accurate charge capture and claim submission. Demonstrates a strong understanding of modifiers and billing regulations for Medicare, Medi-Cal, and commercial insurance payers. Communicate effectively with providers, clinical staff, patients, insurance representatives, and other stakeholders via telephone and email to resolve billing issues and support timely reimbursement. Maintains compliance with organizational policies and regulatory requirements. Performs other duties as assigned.

Education and Experience: Bachelor's degree in healthcare administration, Business, Accounting, or a related discipline preferred. A minimum of two (2) years of progressively responsible experience in medical billing, claims processing, or revenue cycle management is required. Experience with behavioral health billing, payer regulations, and electronic health record systems is highly desirable.

Knowledge and Skills: Knowledge of California healthcare and behavioral health billing regulations, CPT and ICD-10 coding principles, reimbursement methodologies, health insurance contracts, and payer-specific billing requirements. Proficiency in electronic medical record (EMR) systems, particularly Epic, as well as Microsoft Office applications including Word and Excel, is essential. Must possess strong verbal and written communication skills with the ability to effectively collaborate with clinicians, billing staff, and other departments to resolve issues and ensure timely and accurate claim processing. Demonstrates strong analytical, organizational, and problem-solving abilities, with the capacity to interpret billing and reimbursement information, prioritize multiple tasks, and maintain a high level of accuracy and attention to detail. Must be able to successfully perform the responsibilities of a full-time position, exercise sound judgment, work independently, and consistently meet productivity, quality, and performance expectations.

Licensures and Certifications: None