Billing Rules Associate

Essential Functions (Duties and Responsibilities):

80% work, document, and resolve complex client cases

• Provide timely updates and resolution.
• Communicate clearly through written and verbal updates with clients and internal stakeholders. Communicate complex issues or scenarios clearly and concisely.
• Ability to prioritize and multi-task in a fast-paced environment, manage competing priorities and escalations with balanced decision-making.
• Become a subject matter expert in one or more types of healthcare claim submission and billing logic. 
• Use your knowledge of healthcare billing, athenaNet, and billing rules to troubleshoot client issues and determine the root cause of the problem. 
• Understand the context and business reason behind client requirements.
• Validate payer requirements using payer documentation and phone calls to payers.
• Use team guidelines and best practices, compliance requirements, and own judgment to determine whether client requests should be implemented in the billing rules engine.
• Document client and payer requirements using team standards.
• Synthesize large amounts of complex information into clear logic statements.
• Design solutions that meet quality goals.
• Collaborate with colleagues, including developers, to create high-quality billing rule engine updates that meet client needs and payer guidelines.
• Define and execute test plans to validate that technical solutions meet client needs.

20% Be an active participant in athena’s Teach and Learn culture

• Seek out opportunities to grow your knowledge in assigned areas.
• Identify opportunities for process improvement.
• Participate in case retrospective reviews to learn from experiences.
• Support teammates by sharing your process and subject matter expertise.
• Participate in team-wide efforts to improve knowledge management and training.

Education & Experience Required:

• Bachelor’s degree or equivalent
• 5-7 years of experience in a fast-paced environment
• Previous experience in healthcare RCM environment, mandatory
• Familiarity and comfort around web/software applications and a basic understanding of cloud-based SaaS
• Proficiency in Microsoft Office Suite: Excel, PowerPoint, Word, Outlook, OneNote  
• Interest in solving complex Healthcare billing problems

Knowledge & Skills:

• Demonstrates analytical thinking: a systematic, logical approach to managing complex, high volumes and/or contradictory information
• Excellent organizational skills and strong attention to detail
• Manage multiple projects with competing priorities
• Clearly frame a problem statement, research, and troubleshoot
• Clearly communicate complex industry requirements to clients
• Anticipate and balance the needs of multiple stakeholders
• Comfortable learning new programs/tools/applications
• Ability to instruct others, especially peers and clients to explain process workflow concepts
• Proven ability to work both independently on projects and as part of a larger team
• Flexibility to take on new tasks and challenges

About athenahealth

Here’s our vision: To create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.  

What’s unique about our locations? 
From an historic, 19th century arsenal to a converted, landmark power plant, all of athenahealth’s offices were carefully chosen to represent our innovative spirit and promote the most positive and productive work environment for our teams. Our 10 offices across the United States and India — plus numerous remote employees — all work to modernize the healthcare experience, together. 
 
Our company culture might be our best feature. 
We don't take ourselves too seriously. But our work? That’s another story. athenahealth develops and implements products and services that support US healthcare: It’s our chance to create healthier futures for ourselves, for our family and friends, for everyone.  

Our vibrant and talented employees — or athenistas, as we call ourselves — spark the innovation and passion needed to accomplish our goal. We continue to expand our workforce with amazing people who bring diverse backgrounds, experiences, and perspectives at every level, and foster an environment where every athenista feels comfortable bringing their best selves to work. 

Our size makes a difference, too: We are small enough that your individual contributions will stand out — but large enough to grow your career with our resources and established business stability. 
 
Giving back is integral to our culture. Our athenaGives platform strives to support food security, expand access to high-quality healthcare for all, and support STEM education to develop providers and technologists who will provide access to high-quality healthcare for all in the future. As part of the evolution of athenahealth’s Corporate Social Responsibility (CSR) program, we’ve selected nonprofit partners that align with our purpose and let us foster long-term partnerships for charitable giving, employee volunteerism, insight sharing, collaboration, and cross-team engagement.   

What can we do for you? 
Along with health and financial benefits, athenistas enjoy perks specific to each location, including commuter support, employee assistance programs, tuition assistance, employee resource groups, and collaborative workspaces — some offices even welcome dogs.  

In addition to our traditional benefits and perks, we sponsor events throughout the year, including book clubs, external speakers, and hackathons. And we provide athenistas with a company culture based on learning, the support of an engaged team, and an inclusive environment where all employees are valued.  

We also encourage a better work-life balance for athenistas with our flexibility. While we know in-office collaboration is critical to our vision, we recognize that not all work needs to be done within an office environment, full-time. With consistent communication and digital collaboration tools, athenahealth enables employees to find a balance that feels fulfilling and productive for each individual situation.