About the Role
The Billing Analyst ensures precise and compliant billing across healthcare and long-term care programs by preparing and submitting claims, managing denials, reconciling payments, and collaborating with clinical and financial teams to support timely reimbursement and regulatory adherence.
Responsibilities
- Work with care coordination staff to verify complete and accurate documentation of patient care plans, services, and changes in condition.
- Keep well-organized billing records to support financial accuracy and regulatory compliance.
- Generate, examine, and send invoices and claims to Medicaid and other payers promptly and accurately.
- Apply correct medical codes for diagnoses, treatments, and services in long-term care environments.
- Ensure all claims meet specific payer rules and documentation standards.
- Handle multiple billing accounts at once while adhering to strict deadlines.
- Enforce compliance with consolidated billing requirements, ensuring all patient services are billed appropriately by the organization.
- Review Explanation of Payments/Benefits to detect and resolve unpaid or rejected claims.
- Determine causes of claim denials, file appeals, and resubmit claims when needed.
- Identify denial patterns and work with internal teams to improve billing accuracy and reduce future rejections.
- Monitor accounts receivable and follow up with payers to resolve open balances or discrepancies.
- Match payer reimbursements to submitted claims to verify financial record completeness and correctness.
- Produce financial summaries and support monthly revenue cycle reporting.
- Stay informed about updates in billing regulations, long-term care reimbursement policies, and coding standards.
- Follow all applicable Medicaid, managed care, and federal billing regulations.
- Assist staff with best practices in documentation, billing, and coding to ensure consistent and compliant submissions.
- Carry out additional billing, reporting, and administrative tasks as directed by management.
Work Arrangement
Fully remote, within California
I. Position Overview
- Pacific Health Group is advancing health and wellness through innovative, compassionate, and community-centered care, aiming to empower patients and strengthen communities.
- The Billing Analyst ensures accurate and compliant billing operations across healthcare and long-term care programs, supporting the full revenue cycle from claim submission to reporting.
- This role prepares invoices, manages accounts, and secures timely reimbursement while working with clinical and finance teams to uphold compliance with Medicaid, managed care, and consolidated billing rules, supporting the delivery of critical healthcare services.
III. Work Environment
- Setting: Fully remote, within California.
- Culture: Mission-driven, inclusive, and collaborative environment focused on operational excellence and community impact.
- Structure: Cross-functional role engaging with care coordination, revenue cycle, and finance departments.
- Pace: Fast-paced and detail-oriented, requiring precision, adaptability, and effective time management.
IV. Key Internal & External Relationships
- Internal
- Revenue Cycle Manager & Finance Team: Collaborate to ensure billing accuracy, reconciliation, and compliance.
- Case Managers, Social Workers, & Patient Coordinators: Partner to confirm complete documentation and coding for services provided.
- Operations Team: Work together to refine billing workflows and process improvements.
- External
- Payers & Health Plans: Submit, track, and reconcile claims while maintaining professional and timely communication.
- Regulatory Entities: Ensure compliance with Medicaid and managed care billing standards.
- Vendors & Software Providers: Partner as needed to resolve system or data-related billing issues.
