Revenue Cycle Claims Specialist

Finni Health•,

2d•$75,000 - $85,000

About The Position

As an Revenue Cycle Claims Specialist (Individual Contributor), you will play a critical role in optimizing our revenue cycle operations. Your primary responsibilities will include claims triaging, timely filing, resolving payer rejections, following up on claims with no payer response, addressing claims held due to eligibility, researching and appealing claim denials, managing payer EDI enrollments, ensuring compliance with payer regulations and industry standards, leading workflow optimization initiatives, contributing to RCM strategy and execution, and collaborating with various internal teams to align RCM efforts with business objectives. You will also adapt and take on evolving responsibilities as Finni Health grows.

Requirements

5+ years of relevant experience in revenue cycle management, RCM operations, or related roles, preferably in an early-stage startup, behavioral or mental health, or healthcare tech.
Strong understanding of RCM processes, including billing, claims, collections, denial appeals, and accounts receivable management.
Proven ability to work effectively within a team environment and independently drive RCM initiatives.
Deep understanding of the full revenue cycle, including billing, claims processing, collections, accounts receivable management, payer contracting, and compliance (e.g., CMS billing).
Strong ability to analyze complex RCM data, identify trends, root causes of issues, and implement effective, data-driven solutions to optimize financial performance.
Demonstrated expertise in identifying inefficiencies and driving process improvements for RCM efficiency and effectiveness.
Excellent written and verbal communication skills, with proven ability to effectively collaborate with internal teams and external stakeholders (payers, vendors, providers).
Exceptional organizational and time management skills, with the ability to manage multiple priorities and projects in a fast-paced environment.
Proficient in Google Suite, Slack, CRM/support software, and EHR/RCM management tools.
Passion for Finni’s mission to democratize autism care and empower providers through robust RCM.
Comfortable thriving in a dynamic, fast-paced startup environment, embracing change, and navigating ambiguity with a proactive mindset.

Nice To Haves

Experience with various EMR/EHR work queue management within RCM is a plus.

Responsibilities

Monitor claims approaching timely filing limits and alert the RCM team, working collaboratively to resolve and send claims for billing.
Resolve payer claims rejections by researching the root cause, contacting the payer, and ensuring claims are accepted.
Follow up on claims with no payer response to ensure they are on file with payers.
Identify the root cause of claims held due to eligibility issues and work with various teams to obtain updated coverage information.
Research the root cause of claim denials, contact payers for additional information/clarification if necessary, and appeal claim denials within appeal deadline windows.
Ensure all EDI related enrollments (ERA, EFT) are in place with payers, troubleshoot issues as needed (missing ERAs), and enroll as new payers become in-network.
Ensure strict adherence to payer regulations, industry standards (e.g., CMS billing, NCQA Guidelines, Delegated Credentialing), and internal policies, maintaining high service and compliance standards across all RCM functions.
Lead workflow optimization initiatives within RCM, manage specific projects, and drive continuous process improvements to maximize reimbursement and minimize denials.
Contribute to the development and implementation of effective processes for billing, claims processing, revenue collections, and cash posting, ensuring accuracy and timeliness.
Collaborate extensively with product, provider success, compliance, HR, finance, and other teams to align RCM efforts with overall business objectives and drive strategic goals.
Adapt and take on evolving responsibilities and projects as Finni Health grows and the RCM landscape changes.