Senior Medical Billing Specialist

Work Location:

Sunnyvale, CA - Onsite, 5 days per week

Pay Range: $70,000 - $100,000

Founded in 2010, iHealth is dedicated to empowering people to live healthier lives. The company is a leader in designing and manufacturing consumer‑friendly, mobile personal healthcare products connected through the cloud that allows consumers to easily measure, track, and share vital health information with their doctors. With a focus on delivering high‑quality and accessible products, iHealth is at the forefront of the digital health revolution.

In 2018, iHealth established the Unified Care program to address the issue of managing chronic diseases. iHealth Care specialists support patients beyond the doctor’s office with chronic conditions via Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) to achieve better health outcomes.

In November 2021, iHealth’s COVID‑19 Antigen Rapid Test received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) for over‑the‑counter sales. Since then, iHealth has emerged as a key supplier of at‑home COVID tests to the federal government, state governments, nonprofits, and individual consumers. With its commitment to helping people lead healthier lives, iHealth is poised to continue driving positive change in the healthcare industry.

This position performs complete health insurance payer analysis with respect to medical billing and reimbursement functions and is responsible for all aspects of payer research, communication, and management of complex payer and industry changes that impact iHealth’s revenue cycle for Remote Patient Monitoring, Chronic Care Management and Medical Nutrition Therapy services and its operations or strategies.

• Confirm patient benefits and insurance eligibility by making calls to the insurance provider.
• Follow and adhere to all regulations and guidelines set by Medicare, State programs, and HMO/PPO, etc.
• Engage in end‑to‑end billing process, including charge entry, claim submission (including 837’s and 1500 forms), payment posting, and accounts receivable management and extract reports from billing software.
• Engage in follow‑ups with insurance companies and medical groups to address outstanding claims and denials, ensuring the resubmission of claims & appeal for payment.
• Develop, implement, and execute departmental procedures and processes.
• Collect reimbursements and analyze the revenue data to report trends related to errors & denials.
• Use data to identify trends, areas for improvement, and opportunities for revenue growth.
• Generate insurance reimbursement reports and analytics on key billing metrics, providing insights into the internal and external stakeholders on financial health of the organization.
• Analyze and identify opportunities to optimize revenue capture and reduce revenue leakage.
• Ensure compliance with healthcare billing regulations and stay current with changes in billing and coding guidelines to ensure accurate and compliant billing practices.
• Conduct detailed data audits and clean‑up as scheduled and as needed.
• Analyze patient billing records for completeness and accuracy and obtain additional information and clarification as necessary.
• Conduct billing training for internal and external stakeholders and maintain adequate documentation of meetings.
• Implement strategies to improve claim acceptance rates and reduce denials and enhance the overall billing experience for customers.
• Collaborate with internal teams, supporting the efforts and needs of other departments in a team‑oriented approach. Works closely with IT teams to implement technology enhancements aimed at improving billing efficiency.
• Resolve billing discrepancies by conducting further research and correcting errors.
• Maintain organized documentation of all billing and invoicing activities.
• Send out invoices and maintain a tracking system of incoming and late payments.
• Follow up on late or missed payments and initiate late payment notices to relevant parties.
• Adjust patient bills by reviewing remittance advice.
• Maintain compliance with HIPAA (Health Insurance Portability and Accountability Act of 1996).
• Perform…