Billing Specialist

Role Description

As Hey Jane expands to partner with more payers, we are seeking a highly organized and detail-oriented Billing Specialist with specific expertise in Medicaid. You are someone who thrives in dynamic environments and is motivated by the opportunity to help more patients access care with fewer out-of-pocket costs.

In this role, you will manage the smooth and efficient handling of billing operations, ensuring our workflows and claims remain in strict accordance with coding standards. You will act as a crucial bridge between our Clinical and Clinical Operations teams and our third-party billing partner. From accurately processing claims to resolving complex billing issues and maintaining compliance, you will ensure that the intricacies of insurance reimbursement never slow down our mission.

The ideal candidate has a strong background in medical billing and coding and possesses the analytical skills to navigate the nuances of state-funded programs. You excel at spotting gaps, creating structure where it’s needed, and being persistent in communications to ensure our clinicians can focus on patients rather than administrative hurdles.

Responsibilities

• Ensure a smooth, efficient, and timely claim submission process with minimal denials, including identifying gaps in claims.
• Follow up on unpaid claims, denials, and appeals to ensure maximum reimbursement.
• Investigate and resolve billing discrepancies or coding issues.
• Collaborate with internal teams, including clinicians, to provide charting requirements and necessary documentation for claims submission, training team members on billing processes, and creating workflows for billing operations.
• Provide support and guidance to patients regarding their insurance coverage, financial assistance, and billing inquiries.
• Manage abortion fund invoicing and reimbursements.
• Maintain accurate and organized billing records and documentation.
• Generate and analyze reports to monitor billing performance and identify areas for improvement.
• Support new payor partnerships, working collaboratively with internal and external stakeholders to own billing and coding workflows as we grow.
• Maintain knowledge of current billing and coding regulations and updates.
• Stay up-to-date with changes in insurance policies, fee schedules, and reimbursement rates.
• Assist with other billing-related tasks as needed.

Qualifications

• 2+ years experience as a Billing Specialist in a healthcare setting (preferably in a telehealth setting).
• Deep expertise in Medicaid billing guidelines, including familiarity with state-specific reimbursement rules and eligibility verification.
• Strong proficiency in ICD-10, CPT, and HCPCS coding, particularly as they relate to abortion services and sexual and reproductive health.
• Proven experience managing the full claims lifecycle, including submission, denial management, and appeals.
• Hands-on experience with Electronic Health Records (EHR) and Revenue Cycle Management (RCM) systems.
• Solid understanding of HIPAA regulations and a strict commitment to maintaining patient data privacy.
• Strong attention to detail and accuracy.
• Ability to effectively communicate with patients, insurance companies, and internal stakeholders.
• Proficient in using Excel or Google Sheets.
• Ability to work independently in a fast-paced environment.
• Strong organizational and time management skills.
• Passion for advancing equitable healthcare, with a deep-rooted ability to empathize with Hey Jane patients.

Benefits

• Compensation: $60-65k + equity.
• Remote from approved states (CA, CO, IL, MA, MD, NJ, NY, OR, and WA) with preference in NYC.
• Unlimited vacation.
• Health, dental, and vision insurance with FSA.