Payer Analyst - Rev Cycle Billing & Collections - Sharp Tri City Medical Center - Day Shift - Full Time

Hours:

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On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

This position is covered by a Collective Bargaining Agreement (CBA) with SEIU.

This position was originally posted to ratified SEIU members from 10/1/2026 – 10/9/2026. The position is now available to be filled by internal candidates that are not members of the ratified Bargaining Unit or external candidates to Sharp.

What You Will Do
This position is responsible for ensuring all billing and collecting of claims is completed accurately, timely and according to all guidelines and requirements to ensure proper reimbursement. Follows-up and follows-through to resolve underpaid and denied accounts. Utilizes system to follow-up on underpayments and denials to secure payment. Demonstrates extraordinary commitment to excellence by adhering to departmental excellence criteria.

Required Qualifications

• H.S. Diploma or Equivalent
• 3 Years hospital and/or Medical Office billing and/or collection experience.

Preferred Qualifications

• Associate's degree or higher from an accredited university.

Essential Functions

• The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.
  1. Maintains a safe, clean working environment, including unit-based safety and infection control requirements.
  2. Responsible for meeting collection goals established by the department leadership.
  3. Utilizes QMS to reach daily and weekly goals.
  4. Represents TCMC when claims need to be researched with insurance companies by phone, Internet to verify payment, denial, and patient or guarantor eligibility.
  5. Represents TCMC when claims need to be researched with insurance companies by phone, Internet to verify payment, denial, and patient or guarantor eligibility.
  6. Ensures that all insurance payments and discounts are applied and any remaining balance is transferred to patient liability, if applicable.
  7. Takes personal initiative to bring forward process/performance improvements as identified.
  8. Performs special assigned duties to meet the needs of the department.
  9. Update patient demographic and insurance information in the patient accounting system.
  10. Trends are identified and reported to the Supervisor and Manager.
  11. Attaches supporting documentation to claims. When required verify and update insurance information on the patient’s case(s), to include taking out old payer information, selecting the proper payer number, refreshing and re-triggering the claim, and changing bill dates.
  12. Properly document steps taken while working account by utilizing the notes screen, to include telephone numbers, changes made to the insurance, and contact names.
  13. Attends and contributes to departmental meetings. Distributes new and updated information. Provides input and support to overall organization
  14. Rebill insurance claims by both paper and electronic processes
  15. Audit accounts for missed payments, adjustments, and remark codes
  16. Reviews, audits and collects on underpaid or denied insurance claims and stop loss accounts according to insurance carrier contract, guidelines and requirements to ensure proper reimbursement when rebilling a claim.
  17. Writes and works letters of appeals for all denied or underpaid claims. Works all assigned correspondence and reports within 48 hours of receipt.
  18. Works with appropriate functional department (Medical Records, Clinics, Business Office) focusing on payer specific CPT & ICD-9 codes for appropriate reimbursement.
  19. Review denial codes by report in the patient accounting system for accuracy and trends.

Knowledge, Skills, and Abilities

• Verbal and written communication skills as would allow for effective interaction with carriers and patients.
• Knowledge of and experience in basic follow-up and collection techniques.
• Typing skills of 35-45 wpm.
• Must have good written and verbal communication skills as well as analytical capabilities.
• Must have business office skill sets and able to work with staff to resolve patient accounting system issues.
• Intermediate to advanced experience with Microsoft Office Suite, specifically Word and Excel, and Microsoft Windows.
• Work is occasionally performed according to existing procedures and instructions but often requires analysis of problems and development of solutions. This involves determining appropriate methods and task sequences.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Ability to organize and service large volumes of information and data using Microsoft Excel.
• Reading comprehension skills as would provide for a comprehensive understanding of the various payer contracts to which the hospital is bound.
• Knowledge of and experience in payment and coverage practices and terminology used by contracted payers.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class