Payment Operations Associate
As an Associate, Payments [RCM] at Maven, you will:
Review and process complex claims related to Maven's fertility treatments, procedures, applicable medications, and expenses tied to additional paths to parenthood, in accordance with company policy and benefit plan designs
Review claim to Identify instances of denials, underpayments, overpayments
Prepare and submit timely, well-documented appeals and reconsiderations to insurance payers for expedited re-processing of claims
Communicate directly with insurance representatives to follow up on appeals and resolve claim issues
Identify patterns or trends in denials and escalate systemic issues to management
Verify member eligibility and benefits ahead of and during claims processing
Resolve eligibility discrepancies between payer records and member/benefit plan data
Coordinate prior authorizations where applicable to fertility treatment coverage
Facilitate timely and accurate payments and resolve payment disputes across payers and claims
Post and reconcile payments against expected reimbursement; research underpayments and unapplied cash
Work with both internal and external cross-functional stakeholders to ensure a smooth and efficient payment process
Maintain and improve SOPs for all Revenue Cycle Management processes
We’re looking for you to bring:
2-4 years of experience in revenue cycle management, benefits management, or insurance billing, focused on claims and collections
Understanding of medical billing, coding, insurance claims processing, and revenue cycle management (fertility claims experience is a plus)
Excellent written and spoken communication skills
Proficiency with relevant claims/collections software (Availity, Stedi, or similar)
Proficiency in Microsoft Office tools or Google Suite Tools
Experience leveraging AI tools to streamline processes and workflows
Ability to work independently and as part of a team
Strong organizational skills; demonstrated ability to multi-task and manage time effectively
Bachelor's degree is a plus
The base salary range for this role is $81,000-$95,000 per year. You will also be entitled to receive stock options and benefits. Individual pay decisions are based on a number of factors, including qualifications for the role, experience level, and skillset.
This role requires active work authorization in the US.
Maven embraces a flexible hybrid work model. Our teams primarily operate from the New York Metropolitan area, NY, and remotely via San Francisco/Bay Area, CA, Seattle, WA, Boston, MA, Chicago, IL, and Washington, D.C. For those in our New York City office, we encourage in-person collaboration by requiring team members to work onsite three days a week (Tuesday, Wednesday, Thursday). For those based in San Francisco/Bay Area, CA, Seattle, WA, Boston, MA, Chicago, IL, and Washington, D.C., we encourage in-person collaboration by requiring team members to attend quarterly Work Together Days within these cities. This policy aims to balance remote work flexibility with the benefits of face-to-face interaction.