Billing and Claims Specialist (Remote)

We are looking for a dynamic and motivated Billing and Claims Specialist with a strong background in revenue cycle management, billing, and payroll within a healthcare setting. The ideal candidate will possess a collaborative spirit, exceptional organizational skills, and a passion for optimizing operational efficiency to support our mission of delivering quality doula and lactation services.

Key Responsibilities:

• Revenue Cycle Management: You will collaborate with Clinical and Client Services, Business Development, and others to ensure that Revenue Cycle Management operations are effectively integrated and aligned to support Pacify’s strategic imperatives. Oversee the end-to-end revenue cycle process, ensuring timely and accurate billing, collections, and claims management, including but not limited to:
  • Eligibility and benefits verification
  • Charge Description Master (CDM) oversight
  • Coding research and advisory support
  • Daily volume, revenue, and claims reconciliation
  • Resolving pre-billing payer claim edits
  • Transmission of clean claims to payors
  • Follow-up and resolution of unpaid claims
  • Resolution of payment variances, including identification of trends for corrective action and future prevention
  • Denials Mitigation and Prevention
    • Appealing denials, in collaboration with clinical and other colleagues as applicable
    • Identifying and trending root cause, and leading the implementation of denials prevention measures
  • Payment and adjustment posting and reconciliation
  • Ensuring that fee schedules and contracted reimbursement rates are updated timely in the contract management system
  • Communication of payer policy updates and changes to Pacify leaders as applicable
  • Revenue cycle related customer service
  • Timely credit balance resolution
• Billing & Payroll Oversight: Support billing operations in tandem with VP of Operations, including coding, invoicing, and payroll processes, ensuring compliance with healthcare regulations and best practices. Remain current and ensure compliance with regulatory, third-party payer, and contractual changes impacting revenue cycle operations.
• Collaboration: Foster a collaborative work environment by engaging with Clinical, Client Services and Business Development teams to streamline operations, enhance patient care services, and enable a shared understanding of revenue implications of operational decisions.
• Performance Monitoring: Report on operational metrics and implement strategies to improve efficiency, timely claims, and service quality. Monitor revenue cycle key performance indicators, anticipating, identifying, and analyzing performance opportunities and challenges, and developing and executing an approach to resolve and/or mitigate.
• Process Improvement: Identify areas for operations process enhancement and lead initiatives to implement changes that optimize workflow and operational performance across the organization. Proactively identifying opportunities to optimize operational efficiency and effectiveness, and recommending solutions.
• Reporting: Prepare and present regular reports on operational performance, revenue cycle metrics, and team achievements to senior management.

Qualifications:

• Bachelor’s degree in Business Administration, Healthcare Management, or a related field; Master’s degree preferred.
• 5+ years of experience in billing and claims within a healthcare setting.
• Demonstrated experience with revenue cycle management, billing processes, and payroll administration.
• Technical Skills:
  • Previous experience with managing a revenue cycle integration / transformation that includes business process reengineering, technology integration, and sustained performance at the top quartile in revenue cycle key performance metrics.
  • Significant experience with governmental and non-governmental payers in the provider setting, and demonstrated extensive experience in administering rules and regulations affecting reimbursement for healthcare services.
  • Experience implementing, stabilizing and optimizing technology implementations.
• Soft Skills:
  • Positive attitude with excellent interpersonal, communication and presentation skills.
  • Strong analytical and problem-solving abilities.
  • Ability to work collaboratively and build effective relationships across teams.
• Preferred Licensure or Certification:
  • One of two professional coding certifications/licensures:
    • American Academy of Professional Coders (AAPC) - Certified Professional Coder (CPC)
    • American Health Information Association (AHIMA) - Certified Coding Associate (CCA)
  • In addition to the required professional coding certification, one or more general revenue cycle related professional certification credentials are strongly preferred, e.g.:
    • American Academy of Professional Coders (AAPC) - Certified Professional Coder (CPC)
    • American Health Information Association (AHIMA) - Certified Coding Associate (CCA)
    • AAPC – Certified Professional Biller (CPB)
    • Healthcare Financial Management Association (HFMA) - Certified Revenue Cycle Representation (CRCR) or Certified Healthcare Financial Professional (CHFP)
    • AHIMA - Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)

About Us:

Pacify's mission is to be the leading provider of virtual, value-based care in maternal and pediatric health. Founded in 2014, Pacify’s tech-enabled services deliver personalized doula care and on-demand infant feeding and perinatal support to new and expecting parents to reduce costs and improve outcomes for managed care organizations, public health programs, health systems and employers.

Pacify Health LLC is an Equal Opportunity Employer that is committed to global diversity: It is a place where good people want to work, and customers want to continue to engage in EOE M/F/D/V.