Analyst, Epic Business - Billing (Finance)
Title: Billing and Claims Representative
Reports to: Manager, Patient Financial Services
Classification: Individual Contributor
Location: Boston (Hybrid)
Job description revision number and date: V2.0; 4.24.2025
OrganizationSummary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices in Massachusetts and across the country. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.
Job Summary:
We are seeking a detail-oriented Healthcare Billing and Claims Representative with experience in Epic, Federally Qualified Health Centers (FQHCs), and Massachusetts healthcare billing regulations. The ideal candidate will have a strong understanding of claim form logic, clearinghouses, and 837 files to ensure timely and accurate billing and reimbursement. This role involves working closely with payers, providers, and internal teams to resolve billing issues and optimize revenue cycle efficiency.
Responsibilities:
Analyze claim form logic, including UB-04 and CMS-1500 formats, to ensure proper coding and billing practices
Prepare, review, and submit electronic and paper claims through Epic and various clearinghouses, ensuring compliance with FQHC billing guidelines and Massachusetts-specific regulations
Research and resolve billing discrepancies, missing information, and rejected claims in a timely manner
Collaborate closely with payers and clearinghouses to address discrepancies
Complete assigned charge router work queues to resolve outstanding issues that are preventing timely and compliant claims submission
Ensure accuracy and completeness of 837 claim submissions files and that the upload process is accurate and reconciled
Monitor and reconcile 837 electronic claim files and correct errors for resubmission as needed
Collaborate with IT and clearinghouse to troubleshoot file transmission issues and ensure compliance with electronic data interchange (EDI) standards
Liaise with insurance companies to resolve discrepancies, missing files, and rejected claims
Work with the clearinghouse and CTC/IT to facilitate clean claims submission
Complete claims reconciliation logs to validate what was billed and accepted and to show volume trends of related billing activity by payer
Provide feedback to leadership on payer acceptance, clean claim rates, and process inefficiencies
Maintain accurate records of billing activities and payer communications
Assist with monthly reconciliation and revenue reporting as needed
Ensure claims comply with Medicaid (MassHealth), Medicare, and commercial payer requirements, particularly for FQHCs
Ensure compliance with FQHC-specific guidelines, payer requirements, and Massachusetts healthcare regulations
Stay updated on changes to billing codes, remittance formats, and EDI standards
Develop and implement best practices for claim form logic and claims submission
Other duties as assigned
Required Skills:
Knowledgeable of Massachusetts healthcare billing regulations and payer requirements
Good communication skills, detailed orientated, diligent with strong problem-solving skills
Minimum of 1-3 years of claims submission processes or related experience
Experience working with clearinghouses such as Fin Thrive, Availity, Change Healthcare, or Waystar
Knowledge of medical coding (CPT, ICD-10, HCPCS) and compliance requirements
Experience in Microsoft Office Suite
Strong commitment to quality assurance and exceptional customer service
A strong commitment to C3s mission
Desired Other Skills:
Epic experience preferred
Familiarity with the MassHealth ACO program
Familiarity working in Federally Qualified Health Centers (FQHC)
Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Qualifications:
High school diploma or equivalent required; Associates or Bachelors degree in business, accounting, or healthcare administration is preferred
** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **
