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The Heal product platform is revolutionizing the healthcare experience by putting patients first. We are the undisputed market leader in doctor house calls, telemedicine and remote patient monitoring - using technology to make care delivery smart, efficient and highly personal. We obsess about every detail to ensure that we continue to extend our paradigm-shifting lead to deliver convenience, choice and transformative care to each and every one of our patients.
Make your work matter. Your unique contributions and technical ideas can make a rewarding impact on millions of lives in modernizing the healthcare industry.
Heal has delivered over 150,000 house calls and driven over $60+ million in healthcare cost savings. We are proud to mention our very wide range of notable investors, including: Paul Jacobs, Jeb Bush, Breyer Capital, IRA Capital, Trans-Pacific Technology Fund, Lionel Richie, and more. Additionally, we have won numerous distinguished awards, including: the Web Marketing Association 2018 MobileWebAward for Best Health Care Mobile Application, Top 50 in Digital Health, Most Tech-Friendly Provider, Fierce Innovation Awards - Healthcare 2017, Global Healthcare Magazine: Top 10 Healthcare CEOs, Top 40 Healthcare Transformers of 2018, Disruptor Daily's Top 25 Influencers Shaping the Future of Healthcare, 10 CEOs transforming healthcare in America', CES Innovation Awards, and more. Heal has over 100 major corporate clients and is covered as an in-network benefit with Aetna, Anthem Blue Cross, Blue Shield of California, CareFirst, Cigna, Health Net, Medicare, and United Healthcare. Heal house calls are available across California, Atlanta, Georgia, and Northern Virginia/D.C.
We are changing lives all around the nation. Great people working towards our mission allows for this progress, which is where you come in.
The Role
You will report directly to the Head of Product and own the development of Heal’s next generation medical billing system from the ground-up. You will act as the interface between stakeholders in Accounting, Medical Billing and Clinical to gather and synthesize requirements, propose solutions, define tickets, and work directly with Engineering to build software to automate our medical billing processes. You will have an incredible responsibility owning the definition and product development for the revenue engine powering Heal’s business. You must have prior experience in a sophisticated medical billing environment, processing claims, validations, and bring with you a deep understanding of coding and the role of billers. You must be driven by an exceptionally detail-orientated passion to build systems and processes automated by software. You will work closely with dedicated billing software engineers and will be directly tasked with taking Heal’s billing function to the next level through automation and accurate financial reporting. “Upfront price transparency” is one of Heal’s core values: with Heal, patient’s never get a bill after their appointment. This means our technology does a lot of heavy lifting to ensure we provide real-time cost estimation upfront, as well as accuracy during the claims process at the back-end. In this role, you will own the definition, management and scaling of Heal’s end-to-end billing technology.
About You
- Prior experience managing medical billing systems, coding, claims and eligibility software - whether using modern APIs or legacy platforms
- Keen to document processes billing and claims systems
- Analytical thinker, excited to automate complex manual processes using software to accurately and efficiently to scale volume 10x
- Results-driven and passionate about advancing the most patient-friendly billing experience in the healthcare industry
- Excited to develop products that make a measurable impact on real lives every single day, 365 days a year
- You must bring with you in-depth knowledge and experience in the following areas:
- Translating EOB
- Applying a fee schedule
- Knowing when a deductible or coinsurance should be applied
- Knowing when a claim is scrubbed/failed/rejected/paid
- Knowing where to find codes and what codes to apply based on age/services rendered
- Knowledge of HCFA forms
- When a claim needs to be refunded or is billed incorrectly vs coded incorrectly, ie sometimes wrong codes vs sometimes billed wrong insurance
- Must have an understanding of insurance eligibility
- Must understand various terms of payment from insurers, ie VBC vs FFS vs HMO Cap
- Must be versed in CMS billing guidelines for seniors (Medicare and Medicare Advantage)
Responsibilities
- Understand and define requirements for payer contracts’ front-end workflow processes, claim cycle, charge capture, follow-up, ERA/EFT, denial workflows, collections processes, reimbursement methodologies, ANSI 5010 file types, billing claim forms, in a multi-payer environment including Commercial, Medicaid and Medicare, and deliver practice reporting requirements, including CPT/HCPCS/NDC codes, Quality Reporting/ CMS Star reporting , and HEDIS
- Develop, manage and own Heal’s billing product roadmap, including systems to automate, report and manage cost estimations, payment status, and remittance, working with payers, Medicare, and vendors
- Own the relationship with eligibility vendors, including troubleshooting and acting as our interface to submit and track support tickets through to their resolution by vendors
- Development and integration of third-party platforms as needed (e.g. Stripe, ClearingHouse)
- Deliver system implementation of Federal and State billing guidelines and best practices
- Establish a definitive and up-to-date and centralized repository of all existing and new payer contracts with Business Development, Marketing and Finance, for the purpose of ensuring accuracy in our claims system
- Capture requirements around Heal’s complex billing logic by working with key stakeholders
- Work closely with Heal billers to understand current systems, processes and functions in order to understand what to automate and in what order
- Define billing products and systems, create tickets in JIRA
- Work closely with finance, accounting and accounts receivables
What We Need
- Minimum BA or BSc required in Accounting, Finance, Business, Engineering, or Technology related field
- At least 5 years experience in a Medical Billing function, , ideally in a technical or technology role, building or managing billing systems
- Understanding of billing practices and Revenue Cycle fundamentals
- Prior experience in Project Management, or Product Management role(s)
- Experience in an Agile development environment or technology-driven environment
- Experience writing product requirements in tickets (using JIRA and/or other ticketing systems)
- Experiencing managing a product roadmap
- Experience in a prior technology or innovation-driven company a bonus
- Prior experience healthcare necessary
- Prior experience documenting billing systems, coding, claims, and remittance processes
- Excellent written and verbal communication skills
- Fluent with Microsoft Office (Word, PowerPoint, Excel) and Google Suite (Docs, Sheets)
- Fluent in building flow charts, business
- Fluent in analytics methodology and tools (e.g. Metabase, Tableau, etc.)
- Experience with surveys, market research and analysis
- Exceptional attention to detail
