• Lead Billing Representative

    St. Mary's Healthcare (Amsterdam, NY)


    St. Mary’s Healthcare has been named a 2025 Times Union Top Workplace . We are the first acute care hospital in the Capital Region to earn the distinction since the Times Union launched the recognition program 14 years ago.

     

    Job Requisition: REQ3724

     

    Employment Type: Full-Time Shift: Days

     

    Hours: 8am- 4:30pm

     

    Hours Per Week: 40 hours

     

    Hiring Range: $20.23-$27.06

     

    The actual compensation for this position will be determined based on experience and other factors permitted by law.

    Responsibilities:

    • Perform daily file transfers and follow up with the clearinghouse.

    • Stay updated on all insurance policies and procedures to guide and educate insurance teams.

    • Collaborate with the Senior Claims Analyst to review issues, adjust workflows, and reduce unnecessary workloads.

    • Confirm insurance coverage, determine the need for pre-authorization on denied claims.

    • Monitor high-dollar denials and rebilling of denied claims.

    • Assess financial responsibility for services provided and inform patients and/or practitioners of any non-authorized services.

    • Review, monitor and bill Episode of Care claims for our Managed Care plans.

    • Maintain monthly KPIs and ROI analysis on hospital claim volume.

    • Communicate with patients and practitioners regarding financial responsibility and insurance coverage issues.

    • Maintain detailed documentation in patient account records of all billing activities and claims processed as part of the daily claims reconciliation process.

    • Prepare and complete claims for commercial insurance companies, third-party organizations, and government or self-payers.

    • Research, analyze, and reconcile Medicare/Medicaid billing and reimbursement practices.

    • Consult with appropriate parties to resolve unbilled claims and review recent accounts for proper billing practices and reimbursement.

    Education:

    • High school diploma or GED required. Minimum of three (3) years relevant experience required.

    • Certified Revenue Cycle Representative (CRCR) Certification within twelve (12) months of hire required.