Claims Billing Specialist

Pelago is the world’s leading virtual clinic for Substance Use Management. Our program provides guidance, support and treatment for members seeking to overcome their tobacco, alcohol and opioid use. From unhealthy habits to active substance use disorders, Pelago delivers a personalized solution based on individual health, habits, genetics, and goals, providing care for members wherever they might be on the substance use spectrum.   Pelago's suite of virtual services ranges from education, to cognitive behavioral therapy (CBT) to comprehensive medication-assisted treatment (MAT). Pelago enables employers and health plans to deliver accessible, affordable, and effective treatment for substance misuse.   Pelago has scaled to helping hundreds of employers and health plans and has already helped more than 750,000 members manage their substance use better. We have recently closed our Series C and raised over $151m from leading global investors. If you are passionate about making an impact on the health of others, join us and make it happen!

About the Role: 

We are seeking a Claims Billing Specialist to join our team and ensure seamless claims processing, accurate payment coordination, and efficient resolution of member billing concerns. This role requires expertise in claims management, payor coordination, and medical billing workflows. You will work closely with the Care Team, payors, and members to ensure billing accuracy, claims compliance, and timely resolution of denials and payments.

This is a hybrid role, requiring in-office presence on Tuesdays and Thursdays each week for team collaboration and in-office lunches at our NYC HQ.

In this role you will:

• Claims Processing & Denials Reprocessing: Review, validate, and correct denied claims to ensure proper reimbursement.
• Member Billing Complaints: Investigate billing disputes, validate accuracy, and collaborate with the Care Team to resolve issues efficiently.
• CPT Code Testing: Conduct CPT code validation and ensure compliance with billing and reimbursement guidelines.
• Payor Coordination: Partner with payors to ensure accurate claims processing, ERA (Electronic Remittance Advice), and EFT (Electronic Funds Transfer) setups.
• Payor Support: Handle inquiries from payors regarding claims, payments, and compliance through calls and emails.
• Member Statement Management: Oversee statement workflows within the Apero medical billing tool, ensuring customization and accuracy based on client needs.

The background we are looking for:

• Bachelor’s degree in Healthcare Administration, Billing, Finance, or a related field (or equivalent experience).
• 3+ years of experience in claims processing, medical billing, or revenue cycle management.
• Strong understanding of CPT codes, ERA/EFT processes, and payor billing guidelines.
• Proficiency in medical billing software (Apero experience is a plus).
• Excellent analytical and problem-solving skills.
• Strong communication skills to liaise with Care Teams, payors, and members effectively.
• Detail-oriented and able to manage multiple priorities in a fast-paced environment.

What you’ll love about us:

We have a whole host of perks for our people! From life essentials to nice-to-haves, there are more than a few good reasons to love working with us. We strive to ensure Pelago employees have equitable access to healthcare, wellbeing, time away, and then some.

• Generous and meaningful equity package
• Full Medical, Dental, & Vision coverage 
• 401k Plan
• Unlimited PTO Policy, 10 paid holidays, & company wide “Me Time” Days
• Paid maternity, paternity & new parent leave
• Flexible working environment
• Annual Learning and Development stipend to support continued learning and career development
• Wellness Reimbursement Program 
• Access to Reproductive & Family Planning Care 
• Substance Use Support for employees and family members 

The provided range reflects our US target salary range for this full-time position, which is part of our broader total compensation package, including incentive bonus program, stock options, comprehensive benefits, and incentive pay applicable to eligible roles. Individual pay within the range will vary based on a variety of factors like role-related experience and education, internal pay equity, and other relevant business factors. At Pelago, we are committed to an equitable and fair pay philosophy and review total compensation for our employees at least twice a year.

Base Pay Range$80,000—$100,000 USD