Payment Operations Associate

About the role

As an Associate, Payments [RCM] at Maven, you will:

• Review and process complex claims related to Maven’s fertility treatments, procedures, applicable medications, and expenses tied to additional paths to parenthood, in accordance with company policy and benefit plan designs
• Review claim to identify instances of denials, underpayments, overpayments
• Prepare and submit timely, well-documented appeals and reconsiderations to insurance payers for expedited re-processing of claims
• Communicate directly with insurance representatives to follow up on appeals and resolve claim issues
• Identify patterns or trends in denials and escalate systemic issues to management
• Verify member eligibility and benefits ahead of and during claims processing
• Resolve eligibility discrepancies between payer records and member/benefit plan data
• Coordinate prior authorizations where applicable to fertility treatment coverage
• Facilitate timely and accurate payments and resolve payment disputes across payers and claims
• Post and reconcile payments against expected reimbursement; research underpayments and unapplied cash
• Work with both internal and external cross-functional stakeholders to ensure a smooth and efficient payment process
• Maintain and improve SOPs for all Revenue Cycle Management processes

Requirements

• 2–4 years of experience in revenue cycle management, benefits management, or insurance billing, focused on claims and collections
• Understanding of medical billing, coding, insurance claims processing, and revenue cycle management (fertility claims experience is a plus)
• Proficiency with relevant claims/collections software (Availity, Stedi, or similar)
• Proficiency in Microsoft Office tools or Google Suite tools
• Experience leveraging AI tools to streamline processes and workflows
• Ability to work independently and as part of a team
• Strong organizational skills; demonstrated ability to multi-task and manage time effectively
• Bachelor’s degree is a plus

Pay

The base salary range for this role is $81,000–$95,000 per year. Individual pay decisions are based on qualifications for the role, experience level, and skillset.

Schedule

Maven embraces a flexible hybrid work model. Our teams primarily operate from the New York Metropolitan area, NY, and remotely via San Francisco/Bay Area, CA, Seattle, WA, Boston, MA, Chicago, IL, and Washington, D.C.

• For those in our New York City office, we encourage in-person collaboration by requiring team members to work onsite three days a week (Tuesday, Wednesday, Thursday).
• For those based in San Francisco/Bay Area, CA, Seattle, WA, Boston, MA, Chicago, IL, and Washington, D.C., we encourage in-person collaboration by requiring team members to attend quarterly Work Together Days within these cities.

Benefits

• Maven for Mavens: access to the full platform and specialists, including care for mental health, reproductive health, family planning and pediatrics
• Whole-self care through wellness partnerships
• Hybrid work, in-office meals, and work-together days
• 16 weeks 100% paid parental leave and new parent stipend (for Mavens who’ve been with us for 1 year+)
• Annual professional development stipend and access to a personal career coach through Maven for Mavens
• 401k matching for US-based employees, with immediate vesting

These benefits are applicable to Maven Clinic Co., US-based, full-time employees only. 1099/contract providers are ineligible for these benefits.