Claims Operations Specialist
Everly Health
full-time
Posted on:
Location Type: Hybrid
Location: Austin • Texas • United States
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About the role
- Review insurance claims daily to verify accuracy, completeness, and compliance with billing requirements.
- Follow up on outstanding accounts receivable, including unpaid, underpaid, and denied claims across all payer types.
- Identify recurring denial or claim-related issues and collaborate with internal teams to recommend and implement process improvements.
- Enter and maintain claim-related data in the EHR, including completing manual claims when needed.
- Monitor and report claims activity, including preparing dashboards and reports to support KPI tracking.
- Load allowable schedules and other billing data into the EHR to support operational accuracy.
- Develop, update, and maintain standard operating procedures, process guides, workflows, and other operational documentation.
- Support payer enrollment by preparing required applications, tracking progress, and coordinating with payer representatives.
- Assist with new payer setup within internal systems, including verification of requirements and configuration updates.
- Maintain accurate records related to payer enrollment and credentialing activities.
- Assist with chart review for HEDIS, risk adjustment, and other quality or compliance-related initiatives as assigned.
- Participate in cross-functional projects that support enterprise-wide goals, including administrative tasks and operational support.
- Collaborate with internal teams across the organization to ensure timely completion of assigned tasks and consistent communication.
Requirements
- High school diploma or equivalent required; bachelor’s degree preferred.
- At least 5 years of experience in medical billing, revenue cycle operations, or a related healthcare administrative role.
- Experience working directly with payers on claim follow-up and denial resolution.
- Experience with Athena or another EMR/EHR platform required.
- Solid understanding of medical billing processes, including CPT/ICD coding basics and the full claims lifecycle.
- Familiarity with payer rules, reimbursement practices, and denial management.
- Proficiency with EMR/EHR systems; experience with Athena is a plus.
- Strong organizational skills with the ability to manage multiple tasks and deadlines.
- Clear and professional communication skills.
- High degree of accountability and initiative.
- Ability to recognize issues, interpret trends, and recommend improvements.
- Strong attention to detail and accuracy.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical billingrevenue cycle operationsclaims follow-updenial resolutionCPT codingICD codingclaims lifecyclepayer enrollmentcredentialingHEDIS
Soft skills
organizational skillscommunication skillsaccountabilityinitiativeproblem-solvingattention to detailcollaborationtime managementadaptabilityprocess improvement