Sr. Billing Operations Associate

Wwshemi; United States; Remote; USD 60,000 - 75,000; Full time

Job summary

Lyra Health is seeking a meticulous Billing Associate to support Health Plan Billing Operations. You will handle claim denials, payments posting, and remittance reconciliation for payer partnerships, ensuring accurate and timely processing in a dynamic healthcare setting.

You will analyze EOBs and ERAs to uncover root causes of denials, take ownership of complex denied claims, and prepare appeals with payer-specific requirements.

Qualifications

• Minimum 5 years of progressively responsible experience in healthcare billing.
• Expertise reading EOBs and ERA data to resolve denials.
• Ability to investigate complex payment discrepancies and resubmit claims.
• Strong written and verbal communication with payers and internal teams.
• Experience with posting payments and reconciling remittances.

Responsibilities

• Serve as a subject matter expert in denials, posting, and remittance reconciliation.
• Analyze EOBs and remittance advice to identify root causes and develop resolutions.
• Own complex denied claims and ensure timely resubmission to payers.
• Post high-volume payments accurately and reconcile with bank deposits.
• Identify discrepancies between expected and actual payments and escalate notable issues.
• Lead follow-up on outstanding denials and underpayments via payer portals and calls.
• Prepare documentation for complex appeals and understand payer-specific appeal processes.
• Maintain organized records for audit readiness and SOP compliance.
• Mentor junior team members and contribute to process improvements.

Skills

Healthcare billing

Denials & remittance

EOB/ERA analysis

Data entry accuracy

Payer portal navigation

Job description

About Lyra Health

Lyra Health is a leading provider of evidence-based mental health care, serving more than 20 million people globally in partnership with employers and more than 100 million through health plan and partner relationships. The company has delivered more than 15 million sessions of mental health care, published more than 35 peer-reviewed studies, and delivered unmatched outcomes in terms of access, clinical effectiveness, and cost efficiency. Extensive peer-reviewed research confirms Lyra’s transformative care model helps people recover twice as fast and results in a 26% annual reduction in overall healthcare claims costs. Lyra is transforming access to life-changing mental health care through Lyra Empower, the only fully integrated, AI-powered platform combining the highest-quality care and technology solutions.

About the Role

Lyra is seeking a detail-oriented Billing Associate to support our Health Plan Billing Operations Teams accounts receivable (A/R) function. In this role, you’ll be responsible for performing key billing functions to ensure accurate and timely processing of claim denials and payments from our health plan partners.. This is an excellent opportunity to contribute to a growing team and develop your skills in a dynamic healthcare environment.

What You’ll Do:

• Serve as a subject matter expert in claim denials, payment posting, and remittance reconciliation, independently managing complex queues and demonstrating advanced understanding of workflow optimization.

• Expertly analyze Explanation of Benefits (EOBs) and remittance advice (RAs) to identify intricate root causes of denials or payment discrepancies, developing effective resolution strategies.

• Proactively take ownership of complex denied claims, conducting in-depth investigations, independently correcting intricate errors, and ensuring accurate and timely resubmission of claims to payers.

• Independently manage the accurate and efficient posting of high-volume and complex payments from health plans to patient accounts, ensuring precise allocation, thorough reconciliation with bank deposits, and proactive identification of systemic posting errors.

• Expertly identify, analyze, and independently resolve complex discrepancies between expected and actual payments, escalating only the most novel and high-impact issues.

• Lead proactive follow-up on outstanding denials and underpayments through expert utilization of payer portals, sophisticated phone communication, and clear, persuasive written correspondence.

• Independently prepare comprehensive and well-supported documentation for complex appeals based on nuanced denial reasons, demonstrating a thorough understanding of payer-specific appeal processes and regulations.

• Maintain meticulous and expertly organized records of all actions taken within the billing system, ensuring the highest level of data integrity and audit readiness.

• Collaborate strategically with team members to optimize efficient queue management, proactively contribute to the timely resolution of complex billing issues, and serve as a point of escalation and support for junior team members.

• Consistently adhere to and champion established Standard Operating Procedures (SOPs) and compliance guidelines, demonstrating a deep understanding of regulatory requirements and best practices.

• Proactively identify complex denial or reconciliation issues and independently develop potential solutions, presenting well-reasoned recommendations to senior team members.

• Lead the identification of trends in denials and payment discrepancies, proactively proposing and implementing significant process improvements within your area of expertise.

• Provide mentorship, guidance, and support to junior team members, fostering their professional development and contributing to the overall knowledge and skill level of the team.

What You’ll Bring:

• A minimum of 5 years of progressively responsible experience in healthcare billing, with demonstrable expertise in independently managing complex claim denials, payment posting, and intricate remittance reconciliation.

• Proven subject matter expertise in reading and interpreting complex Explanation of Benefits (EOBs) and electronic remittance advice (ERAs) to resolve a wide range of challenging billing issues.

• Comprehensive and in-depth understanding of the complete claim lifecycle, including intricate and nuanced reasons for claim denials, advanced resolution strategies, and payer-specific rules and regulations.

• Extensive experience independently navigating a variety of complex payer portals and utilizing billing software with advanced proficiency for in-depth claim research, accurate high-volume payment posting and strategic follow-up.

• Exceptional data entry skills with a consistent and verifiable track record of impeccable accuracy in posting high volumes of payments and updating complex claim information.

• Strong attention to detail and highly developed analytical and problem-solving skills to identify subtle and complex discrepancies in payments and intricate denial patterns.

• Outstanding organizational and time management skills, with a proven ability to independently manage complex workloads, strategically prioritize critical tasks and consistently meet demanding deadlines.

• Highly professional and effective written and verbal communication skills, with the ability to clearly, concisely, and persuasively interact with payers and internal teams at all levels.

• A deep understanding of and commitment to consistently adhering to established procedures and guidelines, with the ability to identify and recommend improvements to existing processes.

• A highly proactive, solution-oriented, and leadership-driven approach to independently identifying, analyzing, and resolving complex billing issues, often anticipating challenges and leading with effective solutions.

• Demonstrated experience in mentoring and supporting junior team members, contributing to their growth and development.

"We are an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information or any other category protected by law.