Jobgether
Accountabilities:: Serve as a subject matter expert for clean claim submission and front-end billing processes, with a strong understanding of the claim lifecycle from creation through payer receipt and acceptance. Analyze claim rejections and operational data to identify trends, recurring issues, root causes, and opportunities to improve clean claim performance. Investigate EDI and clearinghouse rejections, duplicate submissions, incorrect or missing ICN information, authorization-related rejections, provider enrollment and NPI registration issues, patient demographic errors, and other submission barriers. Research rejection reasons and provide the necessary documentation, system corrections, operational changes, and supporting information to the appropriate cross-functional teams. Assess issues beyond individual claims to determine the broader populations, payers, workflows, or business processes affected. Identify upstream causes of rejections and develop sustainable solutions that prevent recurrence and reduce downstream denials. Use SQL and Snowflake to retrieve and analyze claim and operational data, quantify issues, identify affected populations, validate root causes, and measure improvements. Use advanced Excel functionality, including pivot tables, lookup functions, and data manipulation, to analyze large datasets and produce actionable reporting. Develop dashboards, reports, automation, tracking tools, and other analytical resources that improve visibility into claim submission and rejection performance. Independently manage complex issue-resolution and improvement initiatives from identification through implementation, including cross-functional coordination, testing, validation, and post-implementation monitoring. Partner with Coding, Insurance Verification, Prior Authorization, provider enrollment, technology, vendor operations, and other teams whose processes influence clean claim submission and acceptance. Maintain ownership of cross-functional issues through successful resolution rather than simply escalating or transferring them. Develop and improve workflows and SOPs that increase claim accuracy, operational efficiency, and first-pass payer acceptance. Monitor key performance indicators, rejection trends, and operational performance to proactively identify emerging issues and improvement opportunities. Prepare and present executive-ready materials covering trends, root causes, remediation activities, project status, and upstream and downstream revenue cycle impacts. Translate complex billing and analytical findings into clear recommendations for operational teams and leadership. Maintain knowledge of payer requirements, billing rules, EDI processes, and other changes affecting claim submission and acceptance. Act as an educator and resource for operational teams on identified issues, process improvements, and best practices. Identify opportunities to leverage data, technology, automation, and workflow improvements to increase clean claim rates and prevent avoidable rejections and denials. Requirements Bachelor's degree in business, healthcare, analytics, or a related field is preferred. 2–3+ years of experience in medical billing, claims operations, revenue cycle management, insurance collections, or a related healthcare function. Strong understanding of healthcare revenue cycle processes and the claim lifecycle, particularly claim creation, submission, clearinghouse processing, payer acceptance, rejection, and denial. Experience investigating claim rejections, EDI transactions, clearinghouse issues, payer requirements, provider enrollment, or other front-end billing issues is strongly preferred. Working knowledge of medical billing and coding concepts, including CPT/HCPCS, ICD-10, modifiers, authorization requirements, payer requirements, and claim identifiers. Proficiency with Microsoft Excel, including pivot tables, lookup functions, data manipulation, and analysis of large datasets. Working knowledge of SQL and experience with a data warehouse or analytics platform such as Snowflake. Ability to independently obtain the data needed to answer business questions using SQL, including effectively leveraging AI-assisted query development when appropriate. Demonstrated ability to analyze data, recognize patterns, investigate root causes, and translate findings into actionable operational solutions. Strong project management and organizational skills, with the ability to independently drive initiatives from problem identification through implementation and post-implementation monitoring. Strong written and verbal communication skills, including the ability to create polished presentations and communicate detailed findings to leadership. Ability to work autonomously, follow complex issues across multiple systems and teams, and proactively determine appropriate next steps. Strong critical-thinking, problem-solving, and solution-oriented mindset. Ability to quickly learn new revenue cycle processes, systems, technologies, and payer requirements. Benefits $58,700–$77,000 USD annual pay range for the U.S. remote position. Compensation may vary based on factors such as skills, years and depth of experience, certifications, and specific work location. Comprehensive medical, dental, and vision benefits for eligible employees and dependents. Life and disability insurance plans. Fertility care benefits and free testing for employees and their immediate families. Pregnancy and baby bonding leave. 401(k) benefits. Commuter benefits. Employee referral program. Remote work opportunity within the United States. How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1