Revenue Cycle Specialist / Payer Operations Specialist

Everly Health's mission is to transform lives with modern, diagnostics-driven care, and we believe that the future of healthcare is meeting people where they are. Headquartered in Austin, Texas, Everly Health is the parent company to Everlywell, Everly Health Solutions, Natalist, and Everly Diagnostics. We've set a new standard of people-focused, diagnostic-driven care that puts patients at the center of their own health journey.

Our infrastructure guides the full testing experience with the support of a national clinician network that's composed of hundreds of physicians, nurses, genetic counselors, PharmDs, and member care specialists. Our solutions make world-class virtual care more attainable with rigorous clinical protocols and best-in-class science to tackle some of the healthcare industry's biggest problems.

We are hiring a Revenue Cycle Specialist / Payer Operations Specialist  that will provide essential support to our Everly Health Solutions organization by ensuring that claims and operations are being done efficiently. The role will be working closely and reporting to our Director of Payer Operations. This position focuses on follow-up and claim resolution, including communication with payers and working in our EMR, Athena.

• Reviews claims on daily basis for completeness and accuracy.
• Claim reporting and dashboarding to support KPI tracking.
• Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
• Identifies denial trends and additional process improvement opportunities to aid revenue cycle operations.
• Data entry as required such as loading allowable schedules into EHR, manual claim entry, and new payer enrollment setup.
• Contributes to and/or creates procedure manuals and standard operating procedures as applicable.
• Supports payer enrollment as applicable including completing and following up on new payer enrollment applications.

• 1-3 years of end to end revenue cycle experience (Independent Laboratory and Telehealth preferred) including claim billing, claim auditing, and denial management.
• Ability to read and interpret insurance explanations of benefits and utilize payer portals.
• Knowledge of laboratory and physician payer enrollment processes including Medicare and Medicaid enrollment.
• Revenue cycle/claims dashboarding and reporting experience preferred.
• Working knowledge of CPTs, HCPCs, ICD-10, LCDs and Modifiers is a must. Strong understanding of laboratory and telehealth E&M coding preferred.
• Understands payor payment regulations including reimbursement schemes, coinsurance, deductibles and contractual adjustments.S
• elf starter with excellent organization and time management skills.
• Experience with Electronic Medical Record systems (EMRs), Athena Preferred.
• Experience with Medicare, Medicaid, Managed Care Organizations, and Commercial Payers required.
• Understanding CMS policy guidelines and state regulations as it pertains to RCM activities required.
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This hourly budget for this position is $21.00 - $26.50 / hour based on the selected candidate's qualifications, market data/ranges, location (ATX or NYC) and internal equity. This position is also eligible for an annual bonus, health, dental, vision & mental health insurance, 401(k) with company match, Flexible PTO, a monthly $100 wellness stipend and various other perks. This role will be 40 hours a week.