Billing Specialist

Overview

This role involves managing insurance accounts receivable (A/R) to ensure timely and accurate resolution across a complex claims portfolio. The Billing Specialist (Insurance A/R) drives follow-up, denial and underpayment resolution, cash acceleration, and process improvements to enhance collections outcomes and reduce operational friction.

The position requires independent project execution, process improvement recommendations, prioritization of competing deliverables, and clear communication to minimize rework.

Responsibilities

Insurance A/R Follow-up & Resolution

• Manage assigned worklists of complex and high-risk accounts, meeting productivity and quality targets.
• Own key insurance collections workflows such as recoupments and billing/coding accuracy processes including quality audits.
• Resolve claim issues including rejections, denials, and underpayments through payer portal review, outreach, documentation review, and escalation.
• Research and resolve exceptions and escalations from teammates and cross-functional partners with thorough documentation.
• Maintain high-quality claim notes and documentation to ensure auditability and efficient handoffs.
• Conduct special projects like targeted payer issue reviews and A/R clean-up; provide support for high-risk billing areas to reduce write-offs and aging risk.

Cash, Reporting, and Operational Rigor

• Support weekly and monthly reporting and reconciliation activities to track collections progress and payer behavior.
• Monitor workload and KPIs; contribute to system and process improvement initiatives.
• Participate in productivity and quality reporting, identifying gaps and opportunities for operational improvement.
• Assist in team training and strengthen standard operating procedure (SOP) documentation.
• Identify and advance AI and automation opportunities within collections workflows; support pilots and adoption.
• Conduct ongoing coding and billing accuracy reviews; implement corrective actions and collaborate with Clinical and QA teams for retraining and performance improvements.

Process Improvement & Cross-Functional Problem Solving

• Identify trending claim issues and root causes; recommend remediation strategies to improve collections.
• Propose workflow enhancements and leverage resources to overcome payer constraints, system limitations, or unclear routing.
• Prioritize competing work and project deliverables with sound judgment; communicate assumptions and clarify requirements to minimize rework.
• Identify opportunities to standardize, automate, and reduce manual processes; support testing and adoption of improvements.
• Collaborate with Product and Engineering teams on testing and validation of revenue cycle management (RCM) workflow enhancements.
• Work cross-functionally with Clinical, Provider Operations, Client/Account partners, Member Support, and others to implement and optimize workflows for health plans, clients, and members.

Success Metrics

• Timely, accurate execution of insurance A/R worklists with strong documentation leading to improved aging and collections outcomes.
• Early identification of trends and root causes with clear recommendations to reduce repeat issues and prevent avoidable denials or write-offs.
• Effective handling of competing priorities with proactive communication to minimize rework and maintain team throughput.
• Increased workflow standardization and efficiency through practical improvements and automation.

Requirements

• Minimum 5 years of Revenue Cycle Management experience with strong knowledge of medical claims and health plan/EAP rules.
• Proficient in claims follow-up across denials, rejections, and underpayments with ability to independently drive resolution.
• Strong root-cause problem-solving skills and attention to detail with a high standard for accuracy and documentation.
• Effective prioritization skills and ability to communicate assumptions early to reduce rework.
• Proficiency in Excel and comfort using data for reporting, reconciliation, and operational decision-making.
• Strong communication and interpersonal skills with ability to collaborate cross-functionally in a fast-paced environment.

Preferred Qualifications

• Experience with behavioral health or mental health service line and telehealth billing.
• Professional coding certification.
• Experience with process improvement and automation initiatives in RCM operations.
• Experience in B2B2C healthcare environments.

Location

This position is open for remote work within the United States and hybrid work for candidates located in the San Francisco area. Candidates must permanently reside in the US full-time. The hybrid model requires working three days per week from the San Francisco office.

Compensation & Benefits

• Hourly pay range: $31.00 to $39.00 per hour, plus equity and benefits.
• Compensation is based on job level, location, relevant experience, skills, and education.
• Benefits package includes stock awards, comprehensive healthcare coverage, monthly wellness stipend, retirement savings match, lifetime membership benefits, generous parental leave, and more.