Claims Operations Specialist at Vida Health

United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Digital HealthIndustries

Requirements

Bachelor’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 (e.g., 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

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

Skills

revenue cycle management

medical billing

claims operations

Excel

pivot tables

VLOOKUP

BigQuery

Looker

NetSuite

Candid

S-codes

pharmacy claims

CPB

CRCS

CMRS

Vida Health

Personalized healthcare programs using technology

About Vida Health

Vida Health provides personalized healthcare programs targeting conditions like diabetes, obesity, depression, and hypertension. The company combines human-centered care with technology, employing registered dietitians, physicians, expert coaches, and therapists who connect with clients through video chats. This personal interaction is enhanced by customized digital interventions and educational content, which are tailored to each member's needs using machine learning and data from devices like glucose monitors and fitness trackers. Vida Health stands out from competitors by adopting a pay-for-performance model, where it only receives payment if it successfully helps clients improve their health outcomes. This commitment to results has led to significant improvements in medication adherence, weight loss, and reductions in depression among users.

San Francisco, CaliforniaHeadquarters

2014Year Founded

$210.6MTotal Funding

LATE_VCCompany Stage

AI & Machine Learning, HealthcareIndustries

501-1,000Employees

Risks

Increased competition from similar digital health platforms threatens Vida Health's market share.

Data privacy concerns could impact consumer trust in Vida Health's services.

Regulatory scrutiny on digital health solutions may increase compliance costs for Vida Health.

Differentiation

Vida Health combines mental and physical health treatment in a single platform.

The company offers a pay-for-performance model, ensuring accountability for health outcomes.

Vida Health integrates with over 100 devices and apps for personalized care.

Upsides

Growing demand for virtual mental health services boosts Vida Health's market potential.

Partnerships with large employers enhance Vida Health's reach and credibility.

Advancements in AI improve Vida Health's personalized healthcare offerings.

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