RCM Workflow Specialist

Joyful Health • New York City, NY

1d

About The Position

Joyful Health is building an AI-powered financial operating system for healthcare practices to simplify financial operations and bring joy back to running a private practice. The healthcare payment system is complex and inefficient, leading to significant revenue loss for practices. Joyful Health aims to fix this financial chaos by providing an AI-driven solution. The company recently announced a $22M Series A funding round led by CRV. This role is for individuals excited about combining RCM expertise with product innovation.

Requirements

• 5+ years of experience in medical billing, A/R, or denials with hands-on, claim-level expertise.
• Deep familiarity with payer portals, eligibility systems, and denial resolution workflows.
• Experience working claims across denial categories and navigating ambiguous payer decisions.
• A track record of using AI tools, automation, or technology to work smarter — this is a non-negotiable. If you haven’t adopted AI into your workflow, this role is not the right fit.
• Relentless problem-solver on denials — there is no claim you won’t find a way to resolve.
• Confident on judgment calls — when a case is ambiguous, you make a call and explain your reasoning.
• Willing to push back — you don’t accept “that’s how we’ve always done it” at face value. If something is wrong, you say so clearly and propose a better approach.
• Comfortable with engineers — engineering communication is direct, fast, and sometimes feels confrontational — but it’s really about getting to the truth quickly. You can hold your own in that environment and communicate your RCM expertise with confidence.
• Detail-obsessed — you care about getting things exactly right, and your documentation reflects it.
• Systems-oriented — you notice patterns across claims, not just individual cases. You’re thinking about what’s causing a category of problem, not just fixing one instance.
• Curious about why — you want to understand why something happened, not just resolve it and move on.
• A clear communicator across audiences — you can write a correction that an engineer can implement, a recommendation that an RCSM can act on, and an SOP that a biller can follow.
• Open to iteration — you approach your own processes with the same curiosity you bring to claims. If there’s a better way to do something, you want to find it.

Nice To Haves

• Experience with specialties like ABA, behavioral health, or complex billing environments (preferred but not required).

Responsibilities

• Execute High-Quality Claims Workflows: Work claims across denial, A/R, and follow-up workflows with a focus on accuracy and decision quality, not volume.
• Perform investigation, correction, and resolution of claims.
• Interact with payer systems, portals, and call centers as needed.
• Get creative when standard paths don’t work — find a way to get the claim resolved.
• Review and Label Agent Decisions: Review a statistical sample of AI agent–closed encounters each week and assess whether the agent’s action was correct, with a written rationale for your decision.
• Provide natural language corrections through the product interface that feed directly into model training.
• Flag patterns in where the agent consistently struggles or makes avoidable errors.
• Make confident calls on ambiguous scenarios — many of these are judgment calls, and sitting on the fence is not an option.
• Structure Data Through Labeling: Translate claim activity into standardized, structured workflow outputs.
• Accurately label: Denial categories and CARC/RARC codes, Root cause reasoning, Recovery actions taken, Outcomes (paid, denied, written off, appealed, etc.).
• Ensure every claim worked and every agent review produces clean, structured data.
• Partner Directly with Product & Engineering: Work alongside engineers in a fast-moving, collaborative environment.
• Tell us when something is wrong — if a proposed workflow doesn’t reflect how billing actually works, say so clearly and explain why.
• Help validate whether features and agent behaviors reflect real-world RCM operations before they are released.
• Act as the voice of the RCM practitioner in product development — you are shaping how the system thinks, not just reviewing what it does.
• Leverage AI tools actively in your work — we expect everyone on this team to be pushing the boundary of what’s possible with the tooling available to them.
• Identify Patterns & Surface Insights: Recognize trends across claims, payers, and denial types.
• Flag inconsistencies, contradictions, or unclear outcomes.
• Surface edge cases and breakdowns in workflows.
• Contribute to improving categorization logic, definitions, and SOP quality.

Benefits

• Comprehensive healthcare benefits
• Unlimited PTO (with a minimum of 10 days off a year)
• Flexibility
• Team that cares about doing this right
• Regular team off-sites
• Investment in your professional development
• Competitive salary + equity in a high-growth company backed by world-class investors.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed