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Everlywell · 1 day ago

Claims Operations Specialist

United States

Full-time

Remote

Senior Level

5+ years exp

Everlywell is a digital health company pioneering biomarker intelligence through AI-powered technology and human insight. The Claims Operations Specialist supports the revenue cycle and payer operations team by managing claims, communicating with payers, and assisting with payer enrollment and operational documentation.

Health CareHealth DiagnosticsMedical

Responsibilities

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

Qualification

Medical billing processesClaims managementEHR systemsCPT/ICD codingPayer enrollmentOrganizational skillsCommunication skillsAttention to detailProblem-solving skills

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

High school diploma or equivalent required

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

Preferred

Bachelor's degree preferred

Company

Everlywell

Glassdoor2.6

Everlywell is a digital health company pioneering the next generation of biomarker intelligence—combining AI-powered technology with human insight to deliver personalized, actionable health answers.

Founded in 2015

Austin, Texas, USA

201-500 employees