RCM Workflow Specialist

Joyful Health • New York, NY

1d

About The Position

Joyful Health is building an AI-powered financial operating system for healthcare practices. Our mission is to bring the joy back to running a private practice by simplifying financial operations so providers can focus on patient care. We spent 10 months working as fractional CFOs for a dozen practices, doing this work side by side with providers as we developed our product. We just closed a funding round led by world-class investors and angels including the founders of MongoDB & KAYAK. If you’re excited about combining real-world RCM expertise with product innovation, we’d love to meet you.

The RCM Workflow Specialist sits at the intersection of revenue cycle operations and product intelligence. This is not a traditional billing role. You are responsible for two things that most billing professionals have never been asked to do together: 1) work real claims at an expert level and 2) translate that expertise into the structured data and direct feedback that powers Joyful’s AI product. Every action you take — every agent decision you review, every denial you analyze, every correction you document — directly improves how our system understands and solves revenue cycle problems. You are both: An expert-level RCM practitioner and A collaborator who shapes how our AI learns. This role is part of the RCM Center of Excellence (CoE) and partners directly with the Engineering and Product teams.

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.
• A relentless problem-solver on denials — there is no claim you won’t find a way to resolve. You’ve built payer relationships, figured out workarounds, and tried things other billers wouldn’t think to try. You can tell us about three creative things you’ve done to get a claim overturned that most people wouldn’t do.
• Confident on judgment calls — when a case is ambiguous, you make a call and explain your reasoning. You don’t default to “maybe” when you mean “no.”
• 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 just 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. These are different things, and you know the difference.
• 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

Responsibilities

• 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 — you find a way to get the claim resolved. There is no such thing as “we can’t do it.”
• 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 (e.g., “We should have checked the payer portal before closing — there was a timely filing issue that needed a retro authorization”)
• 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
• 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
• Work alongside engineers in a fast-moving, collaborative environment — engineers communicate directly and get to the point quickly; you need to be comfortable in that environment and able to hold your own on RCM expertise
• 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
• 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
• Competitive salary + equity in a high-growth company backed by world-class investors.
• Regular team off-sites
• Invest in your professional development

What This Job Offers

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