Billing Analyst

Location: Remote (California Based)

Employment Type: Full-Time

Reports To: Revenue Cycle Manager or Designee

Exempt Status: Non-Exempt

Pay: $24.00 - $26.00 per hour

I. Position Overview

At Pacific Health Group (PHG), we are at the forefront of revolutionizing health and wellness, setting new benchmarks in healthcare services through innovation, compassion, and community-driven care. Our mission is to empower members, uplift families, and positively impact the communities we serve.

The Billing Analyst plays a key role in ensuring accurate, compliant, and efficient billing operations across PHG’s healthcare and long-term care coordination programs. This role supports all revenue cycle processes, including claim preparation, submission, denial management, reconciliation, and reporting.

You will be responsible for preparing and issuing invoices, managing multiple accounts efficiently, and ensuring timely reimbursement from payers. Working cross-functionally with case managers, patient coordinators, and finance staff, the Billing Analyst ensures precision in reimbursement and compliance with Medicaid, managed care, and consolidated billing regulations, and ultimately supporting PHG’s mission to deliver life-changing healthcare services to vulnerable populations.

II. Key Responsibilities

Case Management & Documentation

• Collaborate with case managers, social workers, and patient coordinators to ensure accurate and complete documentation of care plans, services rendered, and changes in patient condition or level of care.
• Maintain detailed, organized billing records that support compliance and accuracy.

Billing, Coding & Invoicing

• Prepare, review, and issue accurate and timely invoices and claims to Medicaid and other payers.
• Assign appropriate medical codes for diagnoses, treatments, and services in long-term care and healthcare settings.
• Ensure all claims comply with payer-specific guidelines and documentation requirements.
• Manage multiple billing accounts simultaneously while meeting strict deadlines.

Consolidated Billing

• Ensure compliance with consolidated billing requirements for health plans, confirming all services provided to members or patients are billed appropriately by Pacific Health Group as the responsible entity.

Denial Management & Follow-Up

• Review EOPs/EOBs (Explanation of Payments/Benefits) to identify and resolve unpaid or denied claims.
• Investigate reasons for claim rejections, prepare appeals, and resubmit claims as necessary.
• Track denial trends and collaborate with internal teams to improve accuracy and reduce future occurrences.

Accounts Receivable & Reconciliation

• Monitor accounts receivable and follow up with payers and health plans to resolve outstanding balances or discrepancies.
• Reconcile payer reimbursements with submitted claims to ensure accuracy and completeness of financial records.
• Prepare financial summaries and assist with monthly revenue cycle reports.

Compliance & Policy Updates

• Stay current on changes in billing regulations, long-term care reimbursement policies, and coding guidelines to maintain compliance and support process improvement.
• Adhere to all Medicaid, managed care, and federal billing regulations.

Training & Education

• Provide support and guidance to staff on documentation, billing, and coding best practices to ensure consistent, compliant submissions.

Other Duties

• Perform other related billing, reporting, and administrative duties as assigned by management.

III. Work Environment

Setting: Fully remote, within California.

Culture: Mission-driven, inclusive, and collaborative environment focused on operational excellence and community impact.

Structure: Cross-functional role engaging with care coordination, revenue cycle, and finance departments.

Pace: Fast-paced and detail-oriented, requiring precision, adaptability, and effective time management.

IV. Key Internal & External Relationships

Internal

• Revenue Cycle Manager & Finance Team: Collaborate to ensure billing accuracy, reconciliation, and compliance.
• Case Managers, Social Workers, & Patient Coordinators: Partner to confirm complete documentation and coding for services provided.
• Operations Team: Work together to refine billing workflows and process improvements.

External

• Payers & Health Plans: Submit, track, and reconcile claims while maintaining professional and timely communication.
• Regulatory Entities: Ensure compliance with Medicaid and managed care billing standards.
• Vendors & Software Providers: Partner as needed to resolve system or data-related billing issues.

Experience

Minimum 2+ years of experience in medical billing or healthcare revenue cycle operations, preferably in long-term care, managed care, or Medicaid environments.

Over 2 years of experience reviewing and processing EOPs/EOBs.

Proven ability to manage multiple priorities and deadlines with accuracy and efficiency.

Knowledge

Strong understanding of ICD-10, CPT, and other medical coding systems.

Familiarity with Medicaid, managed care, and healthcare reimbursement processes.

Knowledge of consolidated billing and payer-specific guidelines.

Technical Skills

Proficiency in medical billing software, EHR systems, and standard office tools (Excel, Word, Outlook).

Ability to analyze billing discrepancies, identify solutions, and maintain meticulous documentation.

Detail Orientation

Exceptional attention to accuracy, organization, and compliance.

Time Off & Leave

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

Health & Wellness

90% Employer-paid Employee-Only Medical Benefits

Flexible Spending Account (FSA)

Short-Term & Long-Term Disability | AD&D

Employee Assistance Program (EAP)

Financial & Professional

401(k) with Company Match

Monthly Stipend

Opportunities for professional development and internal growth

Culture & Perks

Employee Discounts via Great Work Perks and Perks at Work

Quarterly In-Person Events

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.

Job Application & Offer Disclaimer

Pacific Health Group is committed to maintaining a transparent, lawful, and secure hiring process in compliance with California labor laws and employment standards. No candidate will be offered employment without meeting the required qualifications and skillset for the position and successfully completing all steps of our recruitment process, which include:

• Submission of a completed internal application via our HRIS system
• A formal pre-screen with our recruiting team
• Completion of a skills assessment (if applicable to the position)
• Participation in a final interview with hiring leadership
• Receipt of a formal verbal offer from our authorized hiring team

AI & Human Interaction (HI) in Recruitment

Pacific Health Group is committed to fairness, equity, and transparency in our hiring practices. We use AI (Artificial Intelligence) tools to help match candidate resumes against our job descriptions, focusing on qualifications, skillsets, and location. All resumes that meet these criteria are then reviewed by HI (Human Interaction) — our recruiting and HR team. Pacific Health Group remains true to our Equal Employment Opportunity (EEO) statement, ensuring that every candidate is given fair and consistent consideration.