Physician Insurance Analyst 4 - Multi Specialty

The Physician Insurance Analyst 4 completes all assigned EPIC billing/claim edits and ensures all required reports are filed timely and accurately. Identifies opportunities for revenue cycle performance improvements and reports to the management team as it relates to assigned duties. Actively identifies and reports trends, and assists in the development and deployment of training relative to trends in conjunction with the Team Leads, Supervisors, Managers, and/or Directors.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules

Physician Insurance Analyst 4 Job Responsibilities:

• Performs the duties of a Physician Insurance Analyst 1, 2, and 3 and demonstrates leadership by providing training to new staff or deploying insurance updates to existing staff.
• Responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims, while meeting the expected Productivity and Quality Standards on a weekly basis.
• Processes claims for all payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and processes all types of EPIC charge reviews and claim edits. Assure all assigned claims meet clearinghouse and/or payer processing criteria.
• Processes Appeals (levels 1 and 2) and checks claim status via phone/payer website for all payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.).
• Identifies trends and analyzes data, escalating trends to the appropriate leader/teams.
• Ensures payer response reports and rejection/denials reports are worked timely and meet Departmental Productivity and Quality Review Standards.
• Effectively interprets CPT, ICD-10, and APC reimbursements to ensure a strong receivable performance.
• Assures appropriate and timely documentation of all account activity.
• Ensures correspondence is handled appropriately.
• Attends, actively participates in, and, at times, leads team meetings and huddles.
• Assists in department report out emails/monthly metrics reporting.
• As needed, travels to Inova sites/offices to print claims and attachments for submission to insurance payers.

Minimum Qualifications:

• Education: High School or GED
• Experience: 3 years Account Executive Experience in Revenue cycle operations, billing, collections, cash posting, and/or administrative support in physician billing

Preferred Qualifications:

• Extensive EPIC Proficiency: Advanced knowledge and hands-on experience with EPIC systems, including charge review workflows, claim edits, clearinghouse validation, SRG functionality, and insurance follow-up modules. Demonstrated ability to train staff and deploy system updates related to EPIC billing processes.
• Claims Processing Expertise: Proven ability to process and follow up on professional and institutional claims for all payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid) with a high degree of accuracy and adherence to productivity and quality benchmarks.
• Appeals and Denials Management: Strong understanding of level 1 and level 2 appeals processes across multiple payers. Skilled in navigating payer websites and phone systems to resolve denials and ensure timely reimbursement.