Claims Operations SpecialistVida Health • United, WV, US
Claims Operations Specialist
Vida Health • United, WV, US
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- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionBachelor’s degree in Healthcare Administration, Business or a related field, or equivalent practical experience. CPB, CRCS or CMRS strongly preferred. 4+ years of experience in revenue cycle management, medical billing or claims operations. Experience in the digital health space is a plus. Prior experience using Candid or similar RCM platforms is preferred. Advanced Excel skills (e.g., pivot tables,VLOOKUP, formulas). Familiarity with BigQuery, Looker, NetSuite and Candid. Understanding of general healthcare reimbursement principles. Familiarity with pharmacy claims and / or alternative coding (eg., S-codes) preferred. Self-starter with a proactive approach to problem-solving. Strong analytical mindset with the ability to work through ambiguity. Comfortable working independently with minimal direction. Strong attention to detail and accountability for high-quality work. Effective communicator with experience engaging clients directly.
Job Description
Job Description
We are seeking a detail-oriented Claims Operations Specialist to own the end-to-end billing process for both medical and pharmacy claims. This role oversees claim submission, tracking, reconciliation and serves as a key point of contact for internal teams and clients. The ideal candidate is a quick learner with strong analytical skills and a desire to grow in a fast-paced, non-traditional healthcare environment. Experience with digital health, S-codes or pharmacy claims is a plus.
Responsibilities :
- Oversee the full revenue cycle process for both medical and pharmacy claims, including submission, QA, payment posting and AR follow-up.
- Review, investigate and resolve claim denials and rejections to ensure timely and accurate reimbursement.
- Assist with client onboarding, including claims setup, payer integration, Candid configuration and rules engine alignment.
- Perform monthly billing operations such as claims reconciliation, bank reconciliation and revenue validation.
- Serve as a point of contact for clients, participating in onboarding calls, monthly check-ins and responding to billing questions.
- Collaborate with Sales, Product, Data and Client Success teams on RFPs, internal process updates and issue resolution.
Qualifications :
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Operation Specialist • United, WV, US
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