Overview
A healthcare organization specializing in physician enablement is seeking a Medical Claims Billing Specialist (Athena) to manage the accurate and timely processing of insurance claims within the revenue cycle. The organization collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient care experiences through scalable operations and cloud-based technology.
Responsibilities
- Manage accounts receivable by analyzing aged AR and identifying root causes of issues
- Investigate, resolve, and appeal insurance claim denials, including contacting payer representatives
- Make independent decisions on claim adjustments, resubmissions, and appeals
- Collaborate with Performance, Operations, Sales teams, and care center staff as needed
- Support care center go-lives, which may involve overnight travel
- Work with the Revenue Optimization team to ensure reimbursements align with payer contracts
- Utilize denial analysis tools such as the Trizetto platform
- Coordinate directly with practice consultants or physicians to enhance revenue cycle functionality
- Aim to meet daily and monthly departmental Key Performance Indicators (KPIs)
- Perform other assigned duties
Requirements
- High school graduate
- Minimum 3 years of experience in medical billing or equivalent claims processing
- Knowledge of revenue cycle performance drivers and ability to resolve complex claims
- Advanced Microsoft Excel skills preferred (pivot tables, VLOOKUP, formulas)
- Experience with athenaHealth and/or athenaOne required
- Orthopedic medical claims billing experience preferred
- Experience with California payers and portals preferred
- Compliance with HIPAA regulations
Compensation & Benefits
- Hourly base pay ranging from $24 to $26.45, excluding bonuses and benefits
- Eligible for an annual bonus targeted at 10%
- Base pay depends on experience, education, and location
- Medical, dental, vision, life, and pet insurance
- 401(k) retirement plan
- Paid time off
- Wellness programs
Location
This role may require overnight travel to support care center go-lives.
Equal Opportunity
The employer is an equal opportunity organization committed to diversity and inclusion. All qualified applicants will receive consideration without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.