CPSI

Role Description The AR Senior Analyst is responsible for leading advanced A/R follow-up, analysis, and resolution activities to ensure accurate and timely reimbursement for healthcare providers. This role requires deep knowledge of payer policies, denial management, and U.S. healthcare billing regulations. The AR Senior Analyst will handle high-value, aged, and complex claims while providing analytical insights and process improvement recommendations to optimize overall cash flow and reduce days in A/R. In addition to performing detailed claim analysis, the Senior Analyst may mentor junior analysts, support team training, and assist with escalations that impact key revenue cycle performance indicators. Essential Functions: - Conduct in-depth pre-call analysis to determine root causes of unpaid or underpaid claims. - Contact payers through calls, IVRs, or web portals for claim status, resolution, and escalation when necessary. - Handle complex denials and aged accounts by identifying trends and recommending corrective actions. - Document all claim-related activities comprehensively in client software for a compliant and auditable trail. - Interpret and analyze Explanation of Benefits (EOBs), medical documentation, authorizations, and payer correspondence. - Prepare and submit appeals for denied or underpaid claims; ensure adherence to payer-specific timelines. - Monitor and track high-dollar, aged, and specialty claims through to resolution. - Collaborate with team members to improve workflow efficiency and data accuracy. - Support audit requests and ensure strict compliance with HIPAA, ERISA, and payer-specific requirements. - Mentor junior analysts by sharing best practices and supporting performance improvement. Qualifications - Graduate (Bachelor’s degree or equivalent). - Minimum 3–5 years of experience in U.S. healthcare accounts receivable follow-up and denial management, with demonstrated expertise in handling complex and high-value claims. - Strong communication and analytical skills with the ability to present insights to leadership. - Solid understanding of U.S. healthcare reimbursement, payer rules, and regulatory requirements. - Working knowledge of ICD-10, CPT, and HCPCS codes. - Proficiency in Microsoft Office (Excel, Word, PowerPoint) and EHR platforms. - Willingness to work continuous night shifts and flexible schedules when required. Requirements - Bachelor’s degree preferred (Healthcare, Finance, or related field). - Prior experience in U.S. healthcare BPO/RCM strongly preferred. - Exposure to acute EHR systems (hospital-based) and clearinghouses such as Waystar, Realmed, Availity, Change Healthcare, and ViaTrack. - Certification in Medical Billing/Coding (optional but preferred). Skills & Technical Proficiency - Advanced analytical and problem-solving abilities with a focus on data-driven decision-making. - Expertise in denial management, payer follow-ups, and revenue recovery strategies. - Strong attention to detail with the ability to process high volumes of claims accurately. - Effective time management and organizational skills. - Ability to work independently with minimal supervision while supporting team goals. - Excellent interpersonal skills for cross-functional collaboration. - Commitment to confidentiality and strict compliance with HIPAA and internal quality standards. Working Environment/Physical Demands - General office environment: Works generally at a desk in a well-lighted, air-conditioned office, with moderate noise levels. - Periods of stress may occur. - Activities require a significant amount of sitting at office and work desks and in front of a computer monitor. - Some walking and standing relative to interaction with other personnel. Travel Requirements - None Other possible Unofficial Titles Unofficial titles may be given by the manager and used for email signature. Note: Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. This document does not create an employment contract, implied or otherwise. It does not alter the "at will" employment relationship between the company and the employee.

Role Description - Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services. - Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference. - Record after-call actions and perform post-call analysis for the claim follow-up. - Provide accurate information to the insurance company, research available documentation including authorization, physician notes, medical documentation on PM system, interpret explanation of benefits received, etc. prior to making the call. - Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments. - Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms. - Responsible for meeting daily/weekly productivity and quality reasonable work expectations. Responsibilities - Claim processing and submission. - Submit the claim to insurance companies to receive payment for services rendered by a healthcare provider. - Taking denial status from various insurance carriers. - Checking eligibility and verification of policy. - Analysis of the data. - Converting denials into payments. - Follow Health Insurance Portability and Accountability Act (HIPAA). - Account follow up on fresh claims, denials, and appeals. - Checking the claim status as per their suspension and denials. - Achieving weekly/monthly production and audit target. Qualifications - High School (HSC) or graduate or equivalent with strong analytical skills. - 1-3 Years of experience in accounts receivable follow-up/denial management for US healthcare. - Good written and verbal communication skills. - Knowledge of medical terminology, ICD10, CPT, and HCPC coding. - Basic working knowledge of computers. - Willingness to work continuously in night shifts. Preferred - Familiar with healthcare patient billing systems (Practice management) like NextGen, eCW, Carecloud, Docutap. - Familiar with clearinghouse like Waystar, Realmed Availity, change healthcare, via track. - Proficiency with MS Excel, MS Word, google spreadsheet, etc. Other Skills and Abilities - Ability to work independently with minimal supervision. - Good analytical skills, assertive in resolving unpaid claims. - Ability to multi-task and accurately process high volumes of work. - Strong organizational and time management skills. Company Description Individual Contributor

Role Description Responsible for overseeing workforce planning, resource allocation, and optimizing operational efficiency to ensure business continuity. This role involves strategic forecasting, scheduling, and managing workforce analytics to enhance productivity. - Supervisor Requisition Calculation - Documentation of Hiring Requisitions - All requisitions are tracked in the Hiring Tracker, categorized for clarity, and updated regularly to reflect real-time requirements. - Maintaining Active Data - Maintaining a comprehensive and accurate active user datasheet. - Regularly verifying with the operations team to ensure user statuses are up-to-date. - Promptly reflecting changes in user status (e.g., resignation, transfer) in the active data sheet. - Regularly verifying with ZingHR Data to validate the correct active users. - Client Alignment Process - Ensuring proper alignment of users to clients. - Coordinating interviews based on client requisitions and ensuring alignment with the appropriate teams managing those clients. - Documenting the alignment details for transparency. - Communicating the alignment via email to stakeholders. - Onboarding and Post-Joining Processes - Updating client alignment and user details in ZingHR, the HR software. - Entering new user data into the Viewgol Staffing File. - Updating client-based capacity numbers in Viewgol buffer file. Qualifications - Should have completed Graduation - 5+ years of experience in workforce management or operational planning. - Strong analytical and problem-solving skills. - Experience with workforce management software and HR analytics tools. - Excellent leadership and communication abilities. - Ability to handle high-pressure environments and adapt to dynamic business needs. Company Description

Role Description - Review teams’ production for errors and inaccuracies. - Document and publish quality scores. - Counsel and mentor team members to improve their quality scores. - Create cheat sheets and reference guides to assist teams in improving quality. - Be able to move seamlessly into the AR Analyst role temporarily if the need arises. - Identify and report common trends in teams’ production, denials, and any global issues. - Maintain production and quality standards declared by the organization. Qualifications - 5+ Years of experience in US Healthcare RCM in posting transactions and AR Follow-up. - Should have a thorough understanding of Provider claim life cycle. - Must have thorough knowledge of major insurance payers. - Must have thorough knowledge of common denials. - Must know standard practices of RCM. - Must have understanding of common acronyms and nomenclature in US Healthcare. - Should have excellent written and communication skills in English. Good grammar is a must. - Must have fair knowledge of common CPT codes, transaction codes, and reason codes. Requirements - 5+ Years of experience in US Healthcare RCM in posting transactions and AR Follow-up. - Should have a thorough understanding of Provider claim life cycle. - Must have thorough knowledge of major insurance payers. - Must have thorough knowledge of common denials. - Must know standard practices of RCM. - Must have understanding of common acronyms and nomenclature in US Healthcare. - Should have excellent written and communication skills in English. Good grammar is a must. - Must have fair knowledge of common CPT codes, transaction codes, and reason codes. Company Description

Investigates, analyzes, negotiates, resolves, documents and reports on consumer and commercial billing issues and complaints against the organization | Identifies solutions that address billing issues and presents appropriate resolution options to customers | Negotiates and authorizes billing settlements within established limits and adjusts customer accounts Business Support

The Billing and Posting Resolution Provider is responsible for providing TruBridge services to customers. This includes coordinating the day to day activities of a hospital's or clinic’s business office such as patient billing and collection, third-party payer relations, and/or preparation of insurance claims. Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: - Coordinates business office functions and personnel that may include, but is not limited to patient billing, credit and collections, and data entry. - Recommends new processes and changes in current processes. - Implements controls to ensure appropriate submission, billing and credit and collections are kept in accordance with established procedures - Implements appropriate procedures for follow-up on third party approvals, billing, and collection of overdue accounts - Ensures that accurate and timely billing is being done by staff members in accordance with established procedures and third-party requirements - Responsible for consistently meeting production and quality assurance standards - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer - Updates job knowledge by participating in company offered education opportunities - Protects customer information by keeping all information confidential - Processes miscellaneous paperwork - Ability to work with high profile customers with difficult processes - May regularly be asked to help with team projects - Responsible for assisting manager in the management of employees which would include coaching, training and performing necessary disciplinary actions including following up on action plans for their employees. - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer - Ensures employee compliance with dress code, attendance and other company policies. - Processes miscellaneous paperwork and performs other administrative duties as assigned. - As a Billing Coordinator you will also need to: - Must be agile and able to easily shift between tasks - Assist with backlog billing projects, such as advanced claim resolution - Assist with new contract implementation - Review claims to ensure edits are setup correctly - Fill in as a Biller where needed Minimum Requirements: Education/Experience/Certification Requirements - At least 2 years of Medicaid experience. - Excellent communication (written and oral) and interpersonal skills. - Strong organizational, multi-tasking, and time-management skills. - Must be detail oriented and able to follow through on issues to resolution. - Must be able to act both independently and as a team member. - High School Diploma or equivalent combination of education and relevant experience needed. - 1+ years’ experience - Excellent critical thinking, organizational, and time management sills with a strong attention to detail, accuracy, and follow through Why join our team? If you join us, you will receive: - Work remotely with a work/life balance approach - Robust benefits offering, including 401(k) - Generous time off allotments - 10 paid holidays annually - Employer-paid short term disability and life insurance - Paid Parental Leave

Job Description This Medicare Claims Biller is responsible for providing TruBridge services to a Critical Access Hospital client that is located in Texas. This includes coordinating the day to day activities of a hospital's or clinic’s business office such as patient billing and collection, third-party payer relations, and/or preparation of insurance claims. Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: - Coordinates business office functions and personnel that may include, but is not limited to patient billing, credit and collections, and data entry. - Recommends new processes and changes in current processes. - Implements controls to ensure appropriate submission, billing and credit and collections are kept in accordance with established procedures - Implements appropriate procedures for follow-up on third party approvals, billing, and collection of overdue accounts - Ensures that accurate and timely billing is being done by staff members in accordance with established procedures and third-party requirements - Responsible for consistently meeting production and quality assurance standards - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer - Updates job knowledge by participating in company offered education opportunities - Protects customer information by keeping all information confidential - Processes miscellaneous paperwork - Ability to work with high profile customers with difficult processes - May regularly be asked to help with team projects - Responsible for assisting manager in the management of employees which would include coaching, training and performing necessary disciplinary actions including following up on action plans for their employees. - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer - Ensures employee compliance with dress code, attendance and other company policies. - Processes miscellaneous paperwork and performs other administrative duties as assigned. - Minimum Requirements: Education/Experience/Certification Requirements - At least 5 years hospital billing experience, can include time outside of TruBridge - Experience processing Medicare Claims, ideally within the state of Texas - Excellent communication (written and oral) and interpersonal skills. - Strong organizational, multi-tasking, and time-management skills. - Must be detail oriented and able to follow through on issues to resolution. - Must be able to act both independently and as a team member. - High School Diploma or equivalent combination of education and relevant experience needed. - Excellent critical thinking, organizational, and time management sills with a strong attention to detail, accuracy, and follow through Why join our team? - Work remotely with a work/life balance approach - Robust benefits offering, including 401(k) - Generous time off allotments - 10 paid holidays annually - Employer-paid short term disability and life insurance - Paid Parental Leave

The Billing & Posting Resolution Provider - Meditech Expanse position is responsible for acting as a liaison for hospitals and clinics using TruBridge’s complete business office services. They work closely with TruBridge management and hospital employees to bill insurance companies for all hospital, hospital-based physician and clinic bills. They pursue collection of all claims until payment is made by insurance companies; and perform other work associated with the billing process. These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job related duties as required. Goals and objectives are subject to change. All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate. Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: - Prepares and submits hospital, hospital-based physician and clinic claims to third-party insurance carriers either electronically or by hard copy billing. - Secures needed medical documentation required or requested by third party insurances. - Follows up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains. - Processes rejections by either making accounts private or correcting any billing error and resubmitting claims to third-party insurance carriers. - Responsible for consistently meeting production and quality assurance standards. - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer. - Updates job knowledge by participating in company offered education opportunities. - Protects customer information by keeping all information confidential. - Processes miscellaneous paperwork. - Ability to work with high profile customers with difficult processes. - May regularly be asked to help with team projects. - Ensure all claims are submitted daily with a goal of zero errors. - Timely follow up on insurance claim status. - Reading and interpreting an EOB (Explanation of Benefits). - Respond to inquiries by insurance companies. - Denial Management. - Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles. - Review late charge reports and file corrected claims or write off charges as per client policy. - Review reports identifying readmissions or overlapping service dates and ignore, merge, or split-bill according to the payer’s rules and the client’s policy. - Review credit reports, resolve credits belonging to a payer when able, and submit a listing of credits to the facility as required by the payer. Minimum Requirements: Education/Experience/Certification Requirements - Commercial, Blue Cross, Medicaid, Managed Medicaid and Workers Compensation - Critical Access Care Hospital and Rural Health Clinics - Meditech Expanse - UB-04 and 1500 billing - Computer skills. - Experience in CPT and ICD-10 coding. - Familiarity with medical terminology. - Ability to communicate with various insurance payers. - Experience in filing claim appeals with insurance companies to ensure maximum reimbursement. - Responsible use of confidential information. - Strong written and verbal skills. - Ability to multi-task.

Investigates, analyzes, negotiates, resolves, documents and reports on consumer and commercial billing issues and complaints against the organization | Identifies solutions that address billing issues and presents appropriate resolution options to customers | Negotiates and authorizes billing settlements within established limits and adjusts customer accountsBusiness Support

Job Summary: The Billing & Posting Resolution Advocate is responsible for providing TruBridge services to customers. This includes coordinating the day-to-day activities of a hospital or clinic’s business office such as patient billing and collection, third-party payer relations, and/or preparation of insurance claims. Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: - Coordinates business office functions and personnel that may include, but is not limited to patient billing, credit and collections, and data entry. - Recommends new processes and changes in current processes. - Implements controls to ensure appropriate submission, billing and credit and collections are kept in accordance with established procedures. - Implements appropriate procedures for follow-up on third party approvals, billing, and collection of overdue accounts. - Ensures that accurate and timely billing is being done by staff members in accordance with established procedures and third-party requirements. - Responsible for consistently meeting production and quality assurance standards. - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer. - Updates job knowledge by participating in company offered education opportunities. - Protects customer information by keeping all information confidential. - Processes miscellaneous paperwork - Ability to work with high profile customers with difficult processes. - May regularly be asked to help with team projects. - Responsible for assisting manager in the management of employees which would include coaching, training, and performing necessary disciplinary actions including following up on action plans for their employees. - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer. - Ensures employee compliance with dress code, attendance, and other company policies. - Processes miscellaneous paperwork and performs other administrative duties as assigned. - As a Billing and Posting Resolution Advocate you will also need to: - Fill-in as a Biller where needed. - Must be agile and able to easily shift between tasks. - Assist with backlog billing projects, such as advanced claim resolution. - Assist with new contract implementation. - Review claims to ensure edits are setup correctly. Minimum Requirements: Education/Experience/Certification Requirements - At least 3 years hospital billing experience, can include time outside of TruBridge - Excellent communication (written and oral) and interpersonal skills. - Strong organizational, multi-tasking, and time-management skills. - Must be detail oriented and able to follow through on issues to resolution. - Must be able to act both independently and as a team member. - High School Diploma or equivalent combination of education and relevant experience needed. - Excellent critical thinking, organizational, and time management skills with a strong attention to detail, accuracy, and follow through.