Billing and Claims Specialist

Summary

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

Requirements

• 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

Responsibilities

• 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
• Resolve 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

Benefits

Equal Opportunity Employer