Billing Analyst - California Residents ONLY

Job Title: Billing Analyst
Location: Remote – Must reside in California
Employment Type: Full-Time
Reports To: Revenue Cycle Manager or Designee
Hourly Pay Range: $22.00 – $24.00 per hour

About Pacific Health Group
Pacific Health Group is at the forefront of revolutionizing health and wellness. We are setting new benchmarks in healthcare services, leading with groundbreaking approaches and innovative solutions to empower our members, uplift families, and impact communities.

Pacific Health Group's vibrant culture fuels passionate problem-solvers who thrive on collaboration to deliver unparalleled care. Joining us means being part of a progressive movement championing personal and professional growth through industry expertise, advanced tech, and an appreciative community.

Position Summary
The Billing Specialist plays a key role in ensuring accurate documentation, timely billing, and regulatory compliance across member and patient services. This role supports our long-term care coordination programs and works cross-functionally with case managers, patient coordinators, and finance staff to ensure accurate reimbursement, efficient claims management, and billing compliance with Medicaid and consolidated health plans.

Key Responsibilities

• Collaborate with case managers, social workers, patient coordinators, and other staff to ensure complete documentation of patient care plans, services provided, and changes in condition or level of care.
• Assign accurate medical codes (e.g., ICD-10, other relevant codes) for diagnoses, treatments, and services in long-term care settings.
• Prepare and submit claims to Medicaid and other payers, ensuring proper documentation and compliance with guidelines.
• Create invoices and claims for member/patient interactions and outreach activities.
• Ensure compliance with consolidated billing requirements, confirming all services are billed by Pacific Health Group as the designated entity.
• Review, analyze, and appeal denied claims as needed; gather additional documentation or clarification from internal teams to support resubmission.
• Monitor and manage accounts receivable; follow up with payers and health plans to resolve delays or discrepancies and ensure timely reimbursement.
• Reconcile payer reimbursements with submitted claims to maintain accurate billing records.
• Stay current with changes in billing regulations, long-term care reimbursement policies, and coding guidelines to ensure ongoing compliance.
• Provide training or guidance to internal teams on documentation and billing procedures to support accurate and compliant submissions.
• Perform other related duties as assigned by management.

Qualifications

• 1–2 years of experience in medical billing, preferably in long-term care, managed care, or Medicaid environments
• Working knowledge of ICD-10 and consolidated billing processes
• Familiarity with denial management, appeals, and accounts receivable follow-up
• Strong attention to detail and documentation accuracy
• Ability to work independently and manage multiple tasks and deadlines
• Excellent communication skills for working cross-functionally with internal staff and external payers
• Proficiency in medical billing software and standard office tools
• Associate’s degree or medical billing/coding certification preferred

Benefits & Perks

• 160 Hours of Paid Time Off (PTO)
• 12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
• 4 Paid Volunteer Hours per Month to support causes you care about
• Bereavement Leave, including Fur Baby Bereavement
• 90% Employer-paid Employee-Only Medical Benefits
• Dental and Vision Insurance
• FSA | Dependent Care Account
• 401(k) with Company Match
• Monthly Stipend
• Short-Term & Long-Term Disability | AD&D
• Employee Assistance Program (EAP)
• Employee Discounts via Great Work Perks and Perks at Work
• Quarterly In-Person Events
• Fully remote work within California
• Opportunities for professional development and internal growth

Equal Opportunity Employer
Pacific Health Group is an Equal Opportunity Employer. We are committed to creating an inclusive and equitable workplace where all individuals are treated with dignity and respect. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy, childbirth, breastfeeding, and related medical conditions), gender, gender identity or gender expression, sexual orientation, national origin or ancestry, citizenship status, physical or mental disability, medical condition (including cancer and genetic characteristics), age (40 and over), marital status, military or veteran status, genetic information, or status as a victim of domestic violence, assault, or stalking. We value diversity in all forms and encourage individuals from historically underrepresented communities to apply.

Pre-Employment Requirements
Employment is contingent upon the successful completion of a background check.