Sr. Billing Operations Associate

Job description

**This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Sr. Billing Operations Associate based in the United States.** We are seeking an experienced and detail-oriented Senior Billing Operations Associate to support healthcare accounts receivable operations and ensure accurate, timely reimbursement from health plan partners. In this role, you will take ownership of complex claim denials, payment posting, remittance reconciliation, and payer follow-up activities. You will use your expertise in healthcare billing to investigate discrepancies, resolve challenging claims, and develop effective appeal strategies. Working within a collaborative, technology-driven healthcare environment, you will help improve billing accuracy, strengthen revenue cycle performance, and maintain compliance with established procedures. You will also identify recurring issues, recommend process improvements, and mentor junior team members to enhance overall team effectiveness. This remote opportunity is ideal for a proactive billing professional who combines strong analytical skills with independent problem-solving and a commitment to operational excellence. ### Accountabilities - **Claims Denial Management:** Independently manage complex denied claims, investigate underlying issues, identify root causes, correct errors, and ensure accurate and timely claim resubmissions to health plan partners. - **Payment Posting and Reconciliation:** Process high volumes of health plan payments accurately, allocate payments to the appropriate patient accounts, reconcile remittance records against bank deposits, and identify systemic posting errors. - **Remittance Analysis:** Review and interpret Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to identify payment discrepancies, understand denial reasons, and determine appropriate resolution strategies. - **Accounts Receivable Follow-Up:** Proactively follow up on outstanding denials, unpaid claims, and underpayments through payer portals, telephone communication, and professional written correspondence. - **Appeals and Dispute Resolution:** Prepare comprehensive, well-supported appeals based on payer-specific requirements, denial codes, contractual terms, and applicable regulations. - **Complex Billing Investigations:** Analyze discrepancies between expected and actual reimbursement, resolve challenging billing issues independently, and escalate novel or high-impact cases when necessary. - **Documentation and Compliance:** Maintain complete, accurate, and well-organized records of billing activities, claim adjustments, payment transactions, and resolution steps to ensure data integrity and audit readiness. - **Workflow and Queue Management:** Manage complex billing queues, prioritize outstanding tasks, and coordinate with colleagues to ensure timely resolution of claims and efficient accounts receivable operations. - **Process Improvement:** Identify recurring denial patterns, reconciliation errors, and operational inefficiencies, then recommend and implement improvements to billing workflows, standard operating procedures, and resolution strategies. - **Team Collaboration and Escalation Support:** Serve as a subject matter expert for complex billing matters, collaborate with internal stakeholders, and provide technical guidance to colleagues on challenging claims and payment issues. - **Mentoring and Knowledge Sharing:** Coach and support junior team members, share best practices, and contribute to the development of team-wide billing expertise. - **Operational Standards:** Follow established standard operating procedures and regulatory requirements while identifying opportunities to improve consistency, efficiency, and the quality of billing operations. ## Requirements - **Professional Experience:** At least five years of progressively responsible experience in healthcare billing, with demonstrated expertise in complex claim denials, payment posting, and remittance reconciliation. - **Claims and Remittance Expertise:** Strong proficiency in interpreting complex EOBs and ERAs, investigating reimbursement discrepancies, understanding denial codes, and identifying appropriate corrective actions. - **Revenue Cycle Knowledge:** Comprehensive understanding of the healthcare claims lifecycle, accounts receivable management, payer reimbursement processes, appeals, underpayments, and payer-specific billing requirements. - **Payer Portal and Billing Systems Proficiency:** Extensive experience navigating multiple payer portals and using billing software to research claims, post payments, update account information, and manage follow-up activities. - **Payment Processing Accuracy:** Exceptional data entry skills and a proven ability to process high volumes of payments and claim updates accurately and consistently. - **Analytical and Problem-Solving Skills:** Strong attention to detail and the ability to investigate complex discrepancies, identify patterns, determine root causes, and develop practical solutions. - **Organization and Time Management:** Excellent organizational skills, with the ability to manage competing priorities, maintain accurate records, handle demanding workloads, and meet deadlines independently. - **Communication Skills:** Strong written and verbal communication skills, including the ability to communicate professionally and persuasively with insurance payers, internal teams, and other stakeholders. - **Process Improvement Mindset:** Ability to follow established procedures consistently while recognizing opportunities to improve workflows, documentation, and billing performance. - **Autonomy and Initiative:** A proactive, solution-oriented approach to complex billing challenges, with the judgment to investigate issues independently and escalate matters appropriately. - **Leadership and Mentoring:** Demonstrated experience supporting, coaching, or mentoring junior team members and contributing to shared team knowledge and performance. - **Adaptability:** Ability to thrive in a fast-paced healthcare environment, respond effectively to changing priorities, and maintain high standards of accuracy and service quality in a remote setting. ## Benefits - **Competitive Annual Salary:** Base salary ranging from $68,000 to $103,500, depending on experience, qualifications, location, and other job-related factors. - **Potential Bonus:** Eligibility for discretionary bonuses, subject to applicable company policies. - **Comprehensive Healthcare Coverage:** Medical, dental, and vision insurance, along with flexible spending accounts (FSA), health savings accounts (HSA), life insurance, and disability coverage. - **Mental Health and Wellbeing Support:** Access to coaching and therapy services, alongside additional wellbeing resources and activities. - **Retirement Savings:** A 401(k) plan with up to 3% employer matching. - **Equity Opportunities:** Eligibility for discretionary restricted stock units (RSUs), providing an opportunity to participate in company ownership. - **Paid Time Off:** Competitive paid leave policies, including vacation, sick days, and company holidays. - **Paid Parental Leave:** Support for employees welcoming a new child. - **Technology Allowance:** Monthly allowance to help cover work-related technology expenses. - **Remote Work Flexibility:** The opportunity to work remotely from within the United States. - **Employee Engagement and Community:** Wellbeing initiatives, team activities, company celebrations, and additional employee appreciation perks. - **Professional Growth:** Opportunities to strengthen healthcare revenue cycle expertise, contribute to operational improvements, and mentor other billing professionals.