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Insurance Billing Specialist



Posted on Sunday, February 11, 2024
Are you looking for a role in a company that's solving one of the greatest challenges of our lifetime?
Ophelia helps people end their opioid use and restore their quality of life with respect for their time and dignity. Our Mission is to make evidence-based treatments for opioid use disorder accessible to everyone... and we're looking to bring more people onto our team to help us achieve it.
Opioid overdose is the #1 cause of death for Americans under 50, but 80% of 3 million Americans with opioid use disorder (OUD) are not getting treatment. Most have jobs, families, and privacy concerns, making it easier to get withdrawal medication from a drug dealer than go to rehab. Meanwhile, 2/3rds of rehabs do not offer medication at all, leading 90% of patients to relapse in the first 3 months. As a result of inadequate access to proven treatment, an American dies of an opioid overdose every 11 minutes.
We are a team of world-renowned doctors, scientists, startup veterans, and White House advisors, backed by leading technology and healthcare investors (Y Combinator, General Catalyst) to re-imagine and re-build addiction treatment in America.
Join us, save lives, and help fix healthcare for those who need it most.
About the Role
Ophelia is hiring an experienced Insurance Billing Specialist who will assist Ophelia by promptly and accurately billing managed care / health plan encounters. We are looking for someone with experience in insurance requirements such as prior authorization and eligibility verification as well as revenue cycle: specifically around claims and denial management at national level with multiple insurance payors.

In this role you will:

  • Assist across the entire spectrum of revenue cycle management, including eligibility and credentialing claims issues as well as patient collections and health plan disputes/grievances.
  • Work with billing partners as needed, ensuring claims are submitted timely and accurately, resolving any front-end data discrepancies prior to claim submission and post claim adjudication.
  • Make necessary adjustments based on billing requirements, updates, or health plan-specific requirements.
  • Coordinate and manage Single Case Agreements with non-participating health plans
  • Stay abreast of reimbursement research, plan communications and industry changes at the state and federal level.
  • Identify and work collaboratively with other team members on obtaining appropriate information needed for a clean claim submission.
  • Other duties as assigned.

We're Looking for Someone Who Has

  • 2-4 years of current and relevant experience in insurance administrative processes.
  • Experience in Behavioral Health billing (preferred)
  • Knowledge of various national payor guidelines and payment methodologies. Familiar with ICD-10, CPT, and HCPCS codes.
  • Experience working in a fast-paced startup environment and who can easily adapt to increased business demands.
  • Extreme detail-orientation, a great team player who also enjoys working independently.
  • Strong organizational skills with the ability to adapt, prioritize and meet deadlines.
  • Excellent computer skills (preferably Google Docs) and experience utilizing various insurance web portals and computer applications.
Interested in learning more about Ophelia and this role? Apply below!