Payments Operations Specialist, Revenue Cycle

Maven Clinic; United States; Hybrid; USD 81,000 - 95,000; Full time

Benefits offered by this job

Hybrid work model

Parental leave 16 weeks

401K matching

Professional development stipend

Job summary

Maven Clinic is seeking an Associate, Payments [RCM] to handle complex fertility-related claims, denials, underpayments, and appeals. You will verify eligibility, coordinate authorizations, and collaborate with internal and external stakeholders to ensure accurate payments.

The role requires 2-4 years in revenue cycle management, strong communication skills, and proficiency with claims software. Base salary range is $81,000-$95,000 per year with stock options and benefits.

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; demonstrated 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, in accordance with company policy and benefit plan designs
• Review claim to Identify instances of denials, underpayments, overpayments
• Prepare and submit timely, well-documented appeals and reconsiderations to insurance payers for expedited re-processing of claims
• Communicate directly with insurance representatives to follow up on appeals and resolve claim issues
• Identify patterns or trends in denials and escalte 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
• Facilitate timely and accurate payments and resolve payment disputes across payers and claims
• Post and reconcile payments against expected reimbursement; research underpayments and unapplied cash
• Work with both internal and external cross-functional stakeholders to ensure a smooth and efficient payment process
• Maintain and improve SOPs for all Revenue Cycle Management processes

Job description

Maven Clinic is seeking an Associate, Payments [RCM] to handle complex fertility-related claims, denials, underpayments, and appeals. You will verify eligibility, coordinate authorizations, and collaborate with internal and external stakeholders to ensure accurate payments.

The role requires 2-4 years in revenue cycle management, strong communication skills, and proficiency with claims software. Base salary range is $81,000-$95,000 per year with stock options and benefits.