Billing Analyst - Remote CALIFORNIA

Position Overview

The Billing Analyst plays a key role in ensuring accurate, compliant, and efficient billing operations across PHG's healthcare and long-term care coordination programs. This role supports all revenue cycle processes, including claim preparation, submission, denial management, reconciliation, and reporting. You will be responsible for preparing and issuing invoices, managing multiple accounts efficiently, and ensuring timely reimbursement from payers. Working cross-functionally with case managers, patient coordinators, and finance staff, the Billing Analyst ensures precision in reimbursement and compliance with Medicaid, managed care, and consolidated billing regulations.

Key Responsibilities

• Collaborate with case managers, social workers, and patient coordinators to ensure accurate and complete documentation of care plans, services rendered, and changes in patient condition or level of care.
• Maintain detailed, organized billing records that support compliance and accuracy.
• Prepare, review, and issue accurate and timely invoices and claims to Medicaid and other payers.
• Assign appropriate medical codes for diagnoses, treatments, and services in long-term care and healthcare settings.
• Ensure all claims comply with payer-specific guidelines and documentation requirements.
• Manage multiple billing accounts simultaneously while meeting strict deadlines.
• Ensure compliance with consolidated billing requirements for health plans, confirming all services provided to members or patients are billed appropriately by Pacific Health Group as the responsible entity.
• Review EOPs/EOBs to identify and resolve unpaid or denied claims.
• Investigate reasons for claim rejections, prepare appeals, and resubmit claims as necessary.
• Track denial trends and collaborate with internal teams to improve accuracy and reduce future occurrences.
• Monitor accounts receivable and follow up with payers and health plans to resolve outstanding balances or discrepancies.
• Reconcile payer reimbursements with submitted claims to ensure accuracy and completeness of financial records.
• Prepare financial summaries and assist with monthly revenue cycle reports.
• Stay current on changes in billing regulations, long-term care reimbursement policies, and coding guidelines to maintain compliance and support process improvement.
• Adhere to all Medicaid, managed care, and federal billing regulations.
• Provide support and guidance to staff on documentation, billing, and coding best practices to ensure consistent, compliant submissions.
• Perform other related billing, reporting, and administrative duties as assigned by management.

Work Environment

Fully remote, within California. Mission-driven, inclusive, and collaborative environment focused on operational excellence and community impact. Cross-functional role engaging with care coordination, revenue cycle, and finance departments. Fast-paced and detail-oriented, requiring precision, adaptability, and effective time management.

Key Internal & External Relationships

• Revenue Cycle Manager & Finance Team: Collaborate to ensure billing accuracy, reconciliation, and compliance.
• Case Managers, Social Workers, & Patient Coordinators: Partner to confirm complete documentation and coding for services provided.
• Operations Team: Work together to refine billing workflows and process improvements.
• External Payers & Health Plans: Submit, track, and reconcile claims while maintaining professional and timely communication.
• Regulatory Entities: Ensure compliance with Medicaid and managed care billing standards.
• Vendors & Software Providers: Partner as needed to resolve system or data-related billing issues.