Position Overview
Pacific Health Group is seeking a Billing Analyst to support accurate, compliant, and efficient billing operations across healthcare and long-term care coordination programs. This role supports revenue cycle processes including claim preparation, submission, denial management, reconciliation, and reporting.
The role involves preparing and issuing invoices, managing multiple accounts, and ensuring timely reimbursement from payers. The Billing Analyst works cross-functionally with case managers, patient coordinators, and finance staff to maintain compliance with Medicaid, managed care, and consolidated billing regulations.
Work Environment
- Fully remote within California
- Cross-functional role supporting care coordination, revenue cycle, and finance teams
- Fast-paced, detail-oriented environment requiring precision and adaptability
Key Responsibilities
- Collaborate with case managers, social workers, and patient coordinators to ensure accurate documentation of care plans, services rendered, and changes in patient condition or level of care
- Maintain organized billing records that support compliance and accuracy
- Prepare, review, and issue invoices and claims to Medicaid and other payers
- Assign appropriate medical codes for diagnoses, treatments, and services in long-term care and healthcare settings
- Ensure claims comply with payer-specific guidelines and documentation requirements
- Manage multiple billing accounts simultaneously while meeting strict deadlines
- Ensure compliance with consolidated billing requirements for health plans
- Review EOPs/EOBs to identify and resolve unpaid or denied claims
- Investigate claim rejections, prepare appeals, and resubmit claims as necessary
- Track denial trends and collaborate with internal teams to improve accuracy and reduce future occurrences
- Monitor accounts receivable and follow up with payers and health plans to resolve outstanding balances or discrepancies
- Reconcile payer reimbursements with submitted claims
- Prepare financial summaries and assist with monthly revenue cycle reports
- Stay current on billing regulations, reimbursement policies, and coding guidelines
- Provide support and guidance to staff on documentation, billing, and coding best practices
- Perform other related billing, reporting, and administrative duties as assigned
Requirements & Qualifications
Experience
- Minimum 2+ years of experience in medical billing or healthcare revenue cycle operations, preferably in long-term care, managed care, or Medicaid environments
- 2+ years of experience reviewing and processing EOPs/EOBs
- Proven ability to manage multiple priorities and deadlines with accuracy and efficiency
Knowledge
- Strong understanding of ICD-10, CPT, and other medical coding systems
- Familiarity with Medicaid, managed care, and healthcare reimbursement processes
- Knowledge of consolidated billing and payer-specific guidelines
Technical Skills
- Proficiency in medical billing software, EHR systems, and standard office tools such as Excel, Word, and Outlook
- Ability to analyze billing discrepancies, identify solutions, and maintain meticulous documentation
Core Competencies
- Exceptional attention to accuracy, organization, and compliance
Benefits & Perks
Time Off & Leave
- 160 hours of paid time off (PTO)
- 12 paid holidays per year, including your birthday and one floating holiday after 1 year of employment
- 4 paid volunteer hours per month
- Bereavement leave, including fur baby bereavement
Health & Wellness
- 90% employer-paid employee-only medical benefits
- Flexible spending account (FSA)
- Short-term and long-term disability
- AD&D coverage
- Employee assistance program (EAP)
Financial & Professional
- 401(k) with company match
- Monthly stipend
- Opportunities for professional development and internal growth
Culture & Perks
- Employee discounts via Great Work Perks and Perks at Work
- Quarterly in-person events
Location
California, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago