Billing Analyst - Remote CALIFORNIA

Pacific Health Group

6h•Remote

About The Position

At Pacific Health Group (PHG), we are at the forefront of revolutionizing health and wellness, setting new benchmarks in healthcare services through innovation, compassion, and community-driven care. Our mission is to empower members, uplift families, and positively impact the communities we serve. The Billing Analyst plays a key role in ensuring accurate, compliant, and efficient billing operations across PHG’s healthcare and long-term care coordination programs. This role supports all revenue cycle processes, including claim preparation, submission, denial management, reconciliation, and reporting. You will be responsible for preparing and issuing invoices, managing multiple accounts efficiently, and ensuring timely reimbursement from payers. Working cross-functionally with case managers, patient coordinators, and finance staff, the Billing Analyst ensures precision in reimbursement and compliance with Medicaid, managed care, and consolidated billing regulations, and ultimately supporting PHG’s mission to deliver life-changing healthcare services to vulnerable populations.

Requirements

Minimum 2+ years of experience in medical billing or healthcare revenue cycle operations, preferably in long-term care, managed care, or Medicaid environments.
Over 2 years of experience reviewing and processing EOPs/EOBs.
Proven ability to manage multiple priorities and deadlines with accuracy and efficiency.
Strong understanding of ICD-10, CPT, and other medical coding systems.
Familiarity with Medicaid, managed care, and healthcare reimbursement processes.
Knowledge of consolidated billing and payer-specific guidelines.
Proficiency in medical billing software, EHR systems, and standard office tools (Excel, Word, Outlook).
Ability to analyze billing discrepancies, identify solutions, and maintain meticulous documentation.
Exceptional attention to accuracy, organization, and compliance.

Responsibilities

Collaborate with case managers, social workers, and patient coordinators to ensure accurate and complete documentation of care plans, services rendered, and changes in patient condition or level of care.
Maintain detailed, organized billing records that support compliance and accuracy.
Prepare, review, and issue accurate and timely invoices and claims to Medicaid and other payers.
Assign appropriate medical codes for diagnoses, treatments, and services in long-term care and healthcare settings.
Ensure all claims comply with payer-specific guidelines and documentation requirements.
Manage multiple billing accounts simultaneously while meeting strict deadlines.
Ensure compliance with consolidated billing requirements for health plans, confirming all services provided to members or patients are billed appropriately by Pacific Health Group as the responsible entity.
Review EOPs/EOBs (Explanation of Payments/Benefits) to identify and resolve unpaid or denied claims.
Investigate reasons for claim rejections, prepare appeals, and resubmit claims as necessary.
Track denial trends and collaborate with internal teams to improve accuracy and reduce future occurrences.
Monitor accounts receivable and follow up with payers and health plans to resolve outstanding balances or discrepancies.
Reconcile payer reimbursements with submitted claims to ensure accuracy and completeness of financial records.
Prepare financial summaries and assist with monthly revenue cycle reports.
Stay current on changes in billing regulations, long-term care reimbursement policies, and coding guidelines to maintain compliance and support process improvement.
Adhere to all Medicaid, managed care, and federal billing regulations.
Provide support and guidance to staff on documentation, billing, and coding best practices to ensure consistent, compliant submissions.
Perform other related billing, reporting, and administrative duties as assigned by management.

Benefits

160 Hours of Paid Time Off (PTO)
12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
4 Paid Volunteer Hours per Month to support causes you care about
Bereavement Leave, including Fur Baby Bereavement
90% Employer-paid Employee-Only Medical Benefits
Flexible Spending Account (FSA)
Short-Term & Long-Term Disability | AD&D
Employee Assistance Program (EAP)
401(k) with Company Match
Monthly Stipend
Opportunities for professional development and internal growth
Employee Discounts via Great Work Perks and Perks at Work
Quarterly In-Person Events