Hybrid Payments Operations Specialist

Maven Clinic Co.; Northern (KY); Hybrid; USD 81,000 - 95,000; Full time

Benefits offered by this job

Stock options

Benefits

401K matching

Parental leave stipend

Professional development stipend

Career coach

In-office meals

Work Together Days

Job summary

Maven Clinic Co. is a leading virtual clinic specializing in women and family health. We are seeking an Associate, Payments [RCM] to review and process fertility-related claims, manage denials, and file appeals, while coordinating with payers and internal teams.

This role supports a flexible hybrid model across multiple US locations. The ideal candidate has 2–4 years in revenue cycle management, excellent communication, and proficiency with Availity/Stedi or similar tools.

Qualifications

• 2-4 years of experience in revenue cycle management, benefits management, or insurance billing.
• Understanding of medical billing, coding, insurance claims processing, and revenue cycle management (fertility claims experience is a plus).
• Excellent written and spoken communication skills.
• Proficiency with relevant claims/collections software (Availity, Stedi, or similar).
• Proficiency in Microsoft Office tools or Google Suite Tools.
• Experience leveraging AI tools to streamline processes and workflows.
• Ability to work independently and as part of a team.
• Strong organizational skills; demonstrate ability to multi-task and manage time effectively.
• Bachelor's degree is a plus.

Responsibilities

• Review and process complex claims related to Maven's fertility treatments, procedures, applicable medications, and expenses tied to additional paths to parenthood.
• Review claims to identify denials, underpayments, or overpayments.
• Prepare and submit timely, well-documented appeals and reconsiderations to insurance payers for faster re-processing of claims.
• Communicate with insurance representatives to follow up on appeals and resolve claim issues.
• Identify patterns or trends in denials and elevate systemic issues to management.
• Verify member eligibility and benefits ahead of and during claims processing.
• Resolve eligibility discrepancies between payer records and member/benefit plan data.
• Coordinate prior authorizations where applicable to fertility treatment coverage.
• Post and reconcile payments against expected reimbursement; research underpayments and unapplied cash.
• Work with internal/external stakeholders to ensure smooth payment processes.
• Maintain and improve SOPs for Revenue Cycle Management processes.

Skills

Revenue cycle management

Benefits management

Insurance billing

Claims processing

Communication skills

Independent & teamwork

AI tools

Adaptability

Attention to detail

Education

Bachelor's degree

Tools

Availity

Stedi

Microsoft Office

Google Workspace

Job description

Maven Clinic Co. is a leading virtual clinic specializing in women and family health. We are seeking an Associate, Payments [RCM] to review and process fertility-related claims, manage denials, and file appeals, while coordinating with payers and internal teams.

This role supports a flexible hybrid model across multiple US locations. The ideal candidate has 2–4 years in revenue cycle management, excellent communication, and proficiency with Availity/Stedi or similar tools.