Note: The job is a remote job and is open to candidates in USA. Lyra Health is seeking a Sr. Billing Operations Associate to support the accounts receivable function of its Health Plan Billing Operations Teams. The role focuses on resolving complex claim denials, posting and reconciling health plan payments, supporting appeals, and improving billing processes while mentoring junior team members.

Responsibilities

• Serve as a subject matter expert in claim denials, payment posting, and remittance reconciliation, independently managing complex queues and demonstrating advanced understanding of workflow optimization
• Expertly analyze Explanation of Benefits (EOBs) and remittance advice (RAs) to identify intricate root causes of denials or payment discrepancies, developing effective resolution strategies
• Proactively take ownership of complex denied claims, conducting in-depth investigations, independently correcting intricate errors, and ensuring accurate and timely resubmission of claims to payers
• Independently manage the accurate and efficient posting of high-volume and complex payments from health plans to patient accounts, ensuring precise allocation, thorough reconciliation with bank deposits, and proactive identification of systemic posting errors
• Expertly identify, analyze, and independently resolve complex discrepancies between expected and actual payments, escalating only the most novel and high-impact issues
• Lead proactive follow-up on outstanding denials and underpayments through expert utilization of payer portals, sophisticated phone communication, and clear, persuasive written correspondence
• Independently prepare comprehensive and well-supported documentation for complex appeals based on nuanced denial reasons, demonstrating a thorough understanding of payer-specific appeal processes and regulations
• Maintain meticulous and expertly organized records of all actions taken within the billing system, ensuring the highest level of data integrity and audit readiness
• Collaborate strategically with team members to optimize efficient queue management, proactively contribute to the timely resolution of complex billing issues, and serve as a point of escalation and support for junior team members
• Consistently adhere to and champion established Standard Operating Procedures (SOPs) and compliance guidelines, demonstrating a deep understanding of regulatory requirements and best practices
• Proactively identify complex denial or reconciliation issues and independently develop potential solutions, presenting well-reasoned recommendations to senior team members
• Lead the identification of trends in denials and payment discrepancies, proactively proposing and implementing significant process improvements within your area of expertise
• Provide mentorship, guidance, and support to junior team members, fostering their professional development and contributing to the overall knowledge and skill level of the team

Skills

• A minimum of 5 years of progressively responsible experience in healthcare billing, with demonstrable expertise in independently managing complex claim denials, payment posting, and intricate remittance reconciliation
• Proven subject matter expertise in reading and interpreting complex Explanation of Benefits (EOBs) and electronic remittance advice (ERAs) to resolve a wide range of challenging billing issues
• Comprehensive and in-depth understanding of the complete claim lifecycle, including intricate and nuanced reasons for claim denials, advanced resolution strategies, and payer-specific rules and regulations
• Extensive experience independently navigating a variety of complex payer portals and utilizing billing software with advanced proficiency for in-depth claim research, accurate high-volume payment posting, and strategic follow-up
• Exceptional data entry skills with a consistent and verifiable track record of impeccable accuracy in posting high volumes of payments and updating complex claim information
• Strong attention to detail and highly developed analytical and problem-solving skills to identify subtle and complex discrepancies in payments and intricate denial patterns
• Outstanding organizational and time management skills, with a proven ability to independently manage complex workloads, strategically prioritize critical tasks, and consistently meet demanding deadlines
• Highly professional and effective written and verbal communication skills, with the ability to clearly, concisely, and persuasively interact with payers and internal teams at all levels
• A deep understanding of and commitment to consistently adhering to established procedures and guidelines, with the ability to identify and recommend improvements to existing processes
• A highly proactive, solution-oriented, and leadership-driven approach to independently identifying, analyzing, and resolving complex billing issues, often anticipating challenges and leading with effective solutions
• Demonstrated experience in mentoring and supporting junior team members, contributing to their growth and development

Benefits

• Comprehensive healthcare coverage (including medical, dental, vision, FSA/HSA, life and disability insurances)
• Lyra for Lyrians; coaching and therapy services
• Equity in the company through discretionary restricted stock units
• Competitive time off with pay policies including vacation, sick days, and company holidays
• Paid parental leave
• 401K with up to 3% matching
• Monthly tech allowance
• Well-being perks and activities, surprise swag, regular community celebration

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