Healthcare Navigator, Claims & Billing
About Eden Health
Eden Health is a nationally recognized medical practice on a mission to create a world where every person has a relationship with a trusted healthcare provider. Working with employers across the country, Eden Health offers employees 24/7 digital care, same-day in-person primary care, mental health services, physical therapy, and benefits navigation. The Eden Health team is driven by a patient-centric approach, delivering relationship-based collaborative care. With this model, our clients have healthier workforces, increased productivity, and reduced healthcare costs. We are committed to diversity, equity, and integrity, and our teams reflect this. Our hope at Eden Health is to create an environment where each person can do the best and most important work in their careers.
What you will be doing
As a Healthcare Navigator, Claims and Billing, you will be responsible for reviewing and following up on all bills, Explanation of Benefits, and claims submission requests from our patients. You will be handling these inquiries through our patient facing app, e-mail, and phone. You’ll be expected to complete tasks efficiently and effectively while meeting our SLAs and maintaining high patient satisfaction. You will drive a high-touch patient experience by paying close attention to detail while reviewing their claims and bills for accuracy and resolving any processing or billing issues with insurance companies and third party billing representatives. As a Healthcare Navigator, Claims and Billing, you will be expected to go above and beyond with every patient interaction and exceeding their expectations. You will be working closely with our Healthcare Navigators and Virtual Navigators and report to the Manager, Member Experience. This is a full time, fully remote position with flexibility to work within the hours of 8am-6pm EST.
What success looks like
- Efficiently responding to incoming claims and billing inquiries on a day to day basis with a commitment to hospitality, patient-centeredness, and excellence
- Communicating with patients and third parties in adherence with Eden Health’s customer service standards and style guide and using clear, concise, and professional language
- Engaging with insurance companies and external billing teams to verify that claims were processed accurately (and resolving the errors when they were not)
- Act as a subject matter expert (SME) related to claims processing troubleshooting and resolution
- Researching complex benefit and coverage questions, with an ability to simplify difficult concepts for our patients
- Accurately documenting details of calls and steps taken to complete tasks
- Providing timely communication and updates to patients
- Proactively answering patients’ questions and providing information before they ask for it
- Collaborating with other team members (including Healthcare Navigators, Virtual Navigators, and providers) when assistance or expertise is needed
- Identifying opportunities for improving our workflows and resources
- Escalating immediately any cases with any patient dissatisfaction or complaint to relevant team members to ensure the continuous improvement of the patient experience
- Mentoring and coaching new team members as the team grows
- Celebrating insurance navigation success stories and learning from patient feedback, thinking about each patient interaction as an opportunity for continuous improvement
What you will bring
- 2+ years of experience in a Customer Service role
- 3+ years of experience in a Claims Examiner or related role
- Ability to work within the hours of 8am-6pm EST
- Advanced understanding of claims processing procedures, from either a provider or payer perspective
- Advanced knowledge of complex benefits
- Experience advocating on behalf of customers
- An obsession with delivering the highest quality customer experience and going above and beyond for customers
- An interest in using technology to deliver tech enabled insurance navigation
- Excellent verbal and written communication skills and strong attention to detail
- A positive, professional, and empathetic tone with patients
- The desire to be part of a fast-moving startup
- Humor, humility and openness to being profusely appreciated as a hero by our patients
- Ability to adapt to new information quickly
- Ability to understand healthcare, insurance, and billing jargon. Ability to clearly translate and communicate complex information to our customers
- Comfortable working independently and being part of a remote, distributed team
Why Eden Health?
- Remote first company and culture
- Series C Healthtech startup with a mission-driven team that's passionate about helping every person have a relationship with a trusted healthcare provider
- Competitive salary and equity compensation package
- Medical, dental, and vision insurance and commuter benefits
- Dedicated Culture Committee led by CEO
- Learning and development budgets to help you grow and bond with your team
- Positive, inclusive, supportive culture cheering you on your journey
- Strong and quickly growing client base of America’s leading employers
Eden Health is an equal opportunity employer and encourages all applicants from every background and life experience without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
Please note: Eden Health interview requests and job offers only originate from edenhealth.com email addresses (e.g. jsmith@edenhealth.com). Eden Health will never ask for bank information (e.g. account and routing number), social security numbers, passwords, or other sensitive information to be delivered via email. If you receive a scam email or wish to report a security issue involving Eden Health, please notify us at: security@edenhealth.com.