Health Plan Operations Associate

Title: Health Plan Operations Associate

Location: Remote
Type: Full-time
Workplace: hybrid

About the Role

Lyra Health is looking for a detail-oriented and highly motivated team player to support various processes on our Health Plan Billing Operations team as a Health Plan Operations Associate. This unique role offers a diverse opportunity for a well rounded person that enjoys learning and quickly adapts to change. The Health Plan Operations Associate must be comfortable shifting to new tasks assignments as needed within Payment Reconciliation, Patient Billing, and Claims Resolution. Other aspects of the role include following up on claims and working denied claims as needed. Some additional responsibilities on an as needed basis are listed below.

RESPONSIBILITIES

• Reconciliation and balancing of all payments, EFTs, lockboxes and 835 files
• Investigate and apply/reconcile unidentified paymentsAccurate and timely posting of payments and adjustments to patient accounts
• Responsible for completing work queues timely Invoicing patients for cost share balances
• Assist in responding to patient inquiries when neededSetting up payment plans and may be responsible for processing financial assistance applications
• Uses assertive follow-up techniques with payers to drive claims resolution
• Investigate cause of claim submission failures & submit corrected claims to payersIdentifies denial reasons with abilities to decipher and take appropriate next steps to resolve
• Contributes as an effective team member with a problem solving collaborative approach
• Key contributor to process improvement ideas to help streamline efficiencies
• Analyze EOB and remittance information, including co-pays, deductibles, co-insurance, contractual adjustments, denials, etc. to verify accuracy of patient balances
• Other responsibilities as needed including eligibility tasks

Qualifications

• 2+ years of recent experience in medical billing setting in bank reconciliation, payment posting and patient billing
• Attention to detail Ability to read and understand EOBs
• Ability to flourish in a fast-paced, rapidly changing environment
• Collaborates cross functionally
• Comfortable conducting training
• Excellent written and verbal communication skills
• Strong skills in research, troubleshooting & resolving issues
• Experience with Salesforce, SQL, JIRA, Google Sheets, Zendesk, Excel

Ideally, we are looking for a candidate who is open to a hybrid role, who can periodically commute to the office in Burlingame, CA. However, this can be a remote opportunity.