Company Description

MEET MAE

Mae is a venture-backed digital health solution on a mission to improve the health and quality of life for mothers, babies, and those who love them. Mae has created a space where complete digital care meets culturally-competent on-the-ground support. We address access gaps and bolster physical and emotional well-being through continuous engagement, risk assessment, early symptom awareness, and a community-led model of support for our users.

Digital solutions to address cultural deficits in care are at the forefront of femtech innovation and Mae is quickly gaining traction with healthcare payers as a viable solution to address the implicit, explicit, and structural biases that hinder equitable maternal health. In addressing whole-person care and focusing on self-advocacy, education, and community, we seek to improve the outcomes for mothers and birthing people, while also reducing clinical costs of care, at impactful scale. See what we’re doing at www.meetmae.com and @maehealthinc on Instagram.

At Mae, we are:

• Solution-Oriented. We make every problem an opportunity to improve.
• Curious. We demonstrate focused curiosity.
• Mission-connected. We ensure mamas and doulas are heard.
• Adaptable. We learn, adapt, and execute.
• Data-driven. We quantify the uncertainty.
• Accountable. We own our decisions and their outcomes.
• Transparent. We don’t hide the hard stuff.

Job Description

As a billing specialist, you will ensure claims are submitted promptly and accurately to the appropriate payer, with the majority of these being Medicaid Managed Care Organizations (MCOs). The billing specialist will liaise with Mae Health’s program managers and health plan Electronic Data Interchange (EDI) / billing points-of-contact to identify and troubleshoot issues with claims submission and/or payment.

Key Responsibilities Include:

• Claims Review and Processing:

  • Review claims prior to submission for coding accuracy, appropriate rate assignments, and completeness to ensure high standards of “clean claim” submissions, utilizing Candid Health’s RCM (“Candid”) platform

  • Timely reviewing, processing, and submission of claims, tracking claims throughout their life cycle from pre-submission review to final provider payout.

  • Monitors claim statuses and follows up on all claims not processed within Mae’s Service Level Agreements (SLAs) for timely claims processing

• Managing Rejections, Denials, and Appeals:

  • Resolves claim errors and/or discrepancies and expediently communicates any issues to plan EDI point-of-contact and relevant Mae personnel

  • Resolves disputed claims by consulting with appropriate internal and external stakeholders

• Payment Timeliness and Adherence to Mae’s Service Level Agreements (SLAs):

  • Monitors and tracks claim payments in Candid and flag for provider direct-payment accordingly

  • Monitor and process payments Mae’s database for claims in queue for Priority Payout based on SLA requirements for timely payment

• Cross-Functional Reporting and Stakeholder Collaboration:

  • Preparing reports for Mae’s Executive Leadership Team on claims trends, performance against SLAs, and identifying issues or concerns with claims adjudication that require further escalation

  • Provide direct provider support for billing-specific inquiries received via Mae’s customer support database

  • Providing timely and accurate responses to health plan’s EDI points-of-contact for ongoing claims adjudication issues

• Compliance and Documentation:

  • Meticulous record-keeping of claim submissions, status, and pertinent notes to keep internal stakeholders informed

  • Stays up-to-date on information required for claims submission and remittance, and associated contracted rates, including oversight and maintenance of Mae’s Billing Codebook in collaboration with program managers and VP of Partner Success

• Other billing assignments, within skills and abilities:

  • Providing technical assistance and ongoing training support to fellow team members

  • Supporting Mae product team in insights to enhance product, including automation of manual claims processing tasks

Qualifications

What we are looking for in candidates:

• Strong understanding of healthcare billing, coding, and claims-management processes

• Experience with revenue cycle management platforms required; experience with Candid Health strongly preferred

• Dynamic, solution-oriented, and collaborative individuals

• Strong organizational skills and ability to manage multiple workstreams in a fast-paced environment

• Exceptional attention to detail and accuracy in managing member and financial data

• Strong analytical skills and ability to recognize trends and identify inefficiencies

• Strong written and verbal communication and interpersonal skills for Mae executive leadership team, service providers, and payer interactions

• 3 to 5 or more years of previous Medicaid billing experience

Additional Information

• Position type: 1099 contract-to-hire

• Contract length: 6 months

• Working hours: Monday - Friday, 9 AM - 5 PM (ET)

• Compensation: $58,000 to $62,500, depending on experience

• Flexible U.S. work location

All your information will be kept confidential according to EEO guidelines.

We are currently only hiring US based applicants and are unable to sponsor visas.

Mae Health Participates in E-Verify

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9.