RCM Associate, Member AR & Pre-Access (Contractor)

Role

We’re looking for a Billing Specialist who can combine their healthcare experience with a fast-paced and ever-changing environment. You’ll work with the Billing team to support timely and accurate financial clearance and claims submission, research and resolve authorization, referral, eligibility, and member billing questions, and help document and improve team processes so billing is handled correctly from start to finish.

What you’ll be doing

• Review authorization, referral, and eligibility issues from the billing team, and work them to resolution while meeting productivity and quality targets
• Learn and apply payer-specific requirements, including authorizations, referrals, carve-outs, and TPA plans
• Communicate with members to obtain financial information and verify insurance coverage
• Calculate member financial responsibility and provide accurate cost estimates
• Review billing activity and transaction history to answer member billing questions
• Accurately record and reconcile member payments in the practice system
• Identify collection opportunities, including payment plans and hardship applications, and escalate as appropriate
• Coordinate with the coding team and clinicians when coding questions arise, and with Member Support on billing and collection questions
• Maintain accurate and complete member records in the electronic medical record and billing systems
• Pull reports and review balance and authorization data to spot trends, and share findings with your lead or manager
• Flag workflow pain points and suggest improvement ideas
• Support new workflow rollouts and help keep standard operating procedure documentation up to date
• Partner with teammates, and occasionally Product / Engineering, to resolve RCM issues
• Escalate complex or unresolved issues to the team lead or manager
• Complete other assignments as requested
• Uphold HIPAA compliance guidelines and all relevant regulations

What you need to have

• 3+ years of Revenue Cycle Management experience, with working knowledge of medical billing claims
• Familiarity with financial clearance, insurance verification, or authorizations
• Experience speaking directly with members or patients about billing or insurance
• Working knowledge of billing, coding, and claims follow-up
• Experience communicating with payers to resolve issues
• Proficiency in Excel and comfort with basic data analysis
• Comfort with claims billing software and Microsoft Office, and a desire to learn new tools
• Ability to work across multiple systems and workflows
• Strong attention to detail and problem-solving skills
• Strong communication and interpersonal skills
• Self-starter who asks questions and learns quickly
• Passion for advocating for Headspace’s members

Preferred:

• Experience in behavioral health, mental health, telehealth, or digital health billing
• Experience in B2B2C healthcare
• Exposure to health plan / EAP