Pacific Health Group is looking for a Billing Analyst to ensure accurate, compliant, and efficient billing operations across our healthcare and long-term care coordination programs. In this role, you will be a key player supporting all revenue cycle processes to maintain financial integrity and operational excellence.
What You'll Do
- Collaborate with case managers, social workers, and patient coordinators to ensure accurate and complete documentation of care plans and services rendered.
- Maintain detailed, organized billing records that support compliance and accuracy.
- Prepare, review, and issue accurate and timely 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 all 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, confirming all services are billed appropriately by Pacific Health Group.
- Review EOPs/EOBs to identify and resolve unpaid or denied claims.
- Investigate reasons for 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.
- Reconcile payer reimbursements with submitted claims to ensure accuracy and completeness of financial records.
- Prepare financial summaries and assist with monthly revenue cycle reports.
- Stay current on changes in billing regulations, long-term care reimbursement policies, and coding guidelines.
- Adhere to all Medicaid, managed care, and federal billing regulations.
- Provide support and guidance to staff on documentation, billing, and coding best practices.
- Perform other related billing, reporting, and administrative duties as assigned.
What We're Looking For
- Demonstrated experience in medical billing, revenue cycle management, or a similar role within a healthcare environment.
- Strong knowledge of Medicaid billing regulations, managed care plans, and medical coding practices.
- Ability to interpret Explanation of Payments/Benefits (EOPs/EOBs) and manage claim denial resolution.
- Exceptional attention to detail and organizational skills for managing complex billing records.
- Proven ability to manage multiple accounts and deadlines in a fast-paced setting.
- Understanding of consolidated billing requirements in a long-term care or managed care context.
- Analytical skills to track trends, reconcile accounts, and prepare financial reports.
- Excellent communication and collaboration skills to work effectively with cross-functional teams.
- Commitment to maintaining strict compliance with all applicable billing and healthcare regulations.
Team & Environment
This is a cross-functional role engaging with care coordination, revenue cycle, and finance departments. You will report to the Revenue Cycle Manager or Designee. Our company culture is mission-driven, inclusive, and collaborative, focused on operational excellence and community impact.
Work Mode
This is a remote position. Candidates must be located within the state of California.
