SHMG Business Operations Specialist in Saratoga Springs, New York at Saratoga Hospital

SHMG Business Operations Specialist

Location: Saratoga Springs, NY

Employment Type: Full Time

Shift/Schedule: Day Shift

Department: Saratoga Hospital Medical Group

Salary Range: $22.87—$37.70/hr

About Saratoga Hospital

At Saratoga Hospital, we’ve built a reputation for high-quality, compassionate care and a commitment to the health and well-being of our community. As part of the Albany Med Health System, we combine advanced technology with a deeply personal approach—creating a supportive environment for patients, staff, and providers alike. We believe that exceptional care starts with exceptional people.

About the Role

We’re looking for a dedicated SHMG Business Operations Specialist to join our team and help us continue delivering the level of care our patients and families deserve. In this role, SHMG Business Operations, the Business Operations Specialist, performs activities to ensure appropriate financial reimbursement for SHMG ambulatory services from third party payers. This position acts as liaison between physician practices, and system-level revenue cycle departments. This role is responsible for tracking SHMG ambulatory accounts within assigned work queues in collaboration with physician practice staff, HIS coding staff, payers, Patient Access staff, Case Managers, and financial department staff. Actively contributes to the morale and teamwork of the staff and facility always presenting a positive attitude and patient minded vision with patient satisfaction as the continuing goal.

What You’ll Do

• Uses software such as Medent, Allscripts, Epic, Craneware, 3M, and Meditech. Conducts trend analysis to identify patterns and variances in denied accounts
• Research front end denied accounts relating to authorization, referral or eligibility to determine appropriate response to denial, facilitating resolution of the claim.
• Tracks denied and overturned accounts, compiling routine and ad hoc reports.
• Participate in workgroups and meetings to discuss collaborative findings, assist with identifying common trends and developing possible solutions.
• In partnership with appropriate personnel, develops and implements standardized, organization-wide reporting guidelines and documentation requirements; assists to facilitate training and educational programs for physicians, coders, case managers and/or other affected personnel.
• Acts as a resource for staff questions relating to claim denial rationale, medical necessity and authorization.
• Assists with identifying and resolving system and payer issues resulting in payment delays, incorrect payments or denials.
• Reviews key processes to identify opportunities for improvement in current workflows
• Assists with the development of internal documentation tip sheets or job aids for inclusion in system-level educational materials.

• Demonstrates competency in the use of computer applications and Medical Necessity, Medically Unlikely, OCE edits, and all coding convention and abstracting software and hardware currently in use by the Albany Med Health System
• Critical to this position is the ability to multitask.
• Ability to work under pressure with deadlines.
• Assists Director in variety of documentation improvement initiatives and other HIS projects as required.
• Ensures the appropriate dissemination and communication of all reimbursement regulations, policy and guideline changes to affected personnel
• Interprets data for reimbursement applications.
• Ability to take initiative to perform necessary research and understand how documentation relates to audits, quality measures, reimbursement, and medical necessity

What You Bring

• Credentialed as RHIT, RHIA, CCS, CPC or other equivalent, and 3 years of experience with coding, abstracting, or billing experience, or other relevant experience.
• Associate or bachelor’s degree preferred.
• Working knowledge of ICD-10-CM coding principles and guidelines, Medical Necessity edits, LCDs, NCDs, CARC codes, Remit Codes and Value Based Purchasing. Thorough knowledge of medical terminology, pathophysiology, pharmacology, anatomy, and physiology. Working knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and reimbursement or willingness to obtain this knowledge

• Strong project and process management, leadership and interpersonal skills. Excellent written and oral communication skills. Critical thinking skills.

Why Saratoga Hospital

• A caring, community-focused culture rooted in teamwork and trust.
• Supportive leadership that invests in your development and well-being
• Comprehensive benefits, including medical, dental, retirement plans, tuition assistance, and wellness programs. Click here to view our complete benefits guide.
• Opportunities to grow within the Albany Med Health System
• Located in beautiful Saratoga Springs, known for its vibrant community, outdoor recreation, and cultural attractions.

Our Commitment

We are an equal opportunity employer and strongly encourage individuals of all backgrounds and experiences to apply. If you’re passionate about healthcare and community service—even if you don’t meet every qualification listed—we’d still love to hear from you.

How to Apply

Click the ‘apply’ button to submit your resume and complete our online application. Applications are reviewed on a rolling basis—apply today and discover what makes Saratoga Hospital a special place to grow your career.