Revenue Cycle Management Consultant
About The Position
Vayu Health is seeking an analytical, detail-oriented Revenue Cycle Management (RCM) Consultant for an ongoing, targeted contract engagement of approximately 40 hours per month. The consultant will audit, clean up, and optimize medical billing operations between Vayu’s clinical teams and its technology platform partner, Sprite Health. The role reports directly to Vayu’s Senior Director of Clinical Operations, with a dotted line to Vayu’s Finance consultant for financial oversight. The consultant will reconcile clinical encounter logs with submitted claims; investigate and dispute denied or zero-paid claims; manually post remittance advice when electronic syncing fails; and track claims and payments outside the RCM platform when necessary. The role also involves working with Sprite Health to resolve platform and reporting issues, improving claims-tracking workflows, and maintaining revenue-cycle dashboards for Vayu’s finance and accounting team. Vayu Health is a nonprofit startup operated with for-profit operational efficiency. It provides personalized, whole-person, value-based care to rising- and high-risk Medi-Cal members with complex chronic conditions, initially focusing on individuals with uncontrolled diabetes. Its hybrid local and virtual care model pairs community-embedded Community Health Workers with virtual clinical specialists and partners with local Primary Care Providers to address social, behavioral, and structural barriers to health.
Requirements
- Deep, hands-on knowledge of California Medi-Cal billing frameworks.
- Proven ability to identify root causes of $0 payments, missing claims, and unexplained payer denials.
- Direct experience navigating and submitting disputes through California Managed Care Plan portals, specifically Partnership HealthPlan of California and Health Net.
- Experience with RCM/EHR systems and evolving EHR/RCM dashboards.
- Strong data-analysis skills and mastery of Excel.
- Comfort managing data manually or working with the Vayu team to create automations when system automations lag.
- Exceptional communication skills to coordinate between clinical operations, billing vendors, and payers and drive prompt issue resolution.
Nice To Haves
- Experience with Enhanced Care Management (ECM) and ECM+ (Diabetes Management) codes and reimbursement structures.
Responsibilities
- Review and cross-reference monthly clinical encounter logs against submitted claims to identify and correct missing, duplicate, or incorrectly formatted ECM, ECM+, and Outreach claims.
- Investigate backlogged $0-paid and denied claims from Q4 2025 and Q1 2026.
- Prepare, track, and electronically submit Provider Dispute Resolutions through provider portals.
- Manually post electronic and paper ERAs/EOBs into the RCM platform when automatic syncing fails, ensuring the dashboard reflects actual revenue received.
- Maintain an independent claims-tracking log when the RCM platform cannot reliably recognize payments or denials.
- Verify timely claim submissions in the Partnership HealthPlan and Health Net portals.
- Reconcile payments and denials against actual bank deposits and prompt Sprite Health to correct repayment values and discrepancies.
- Collaborate with Sprite Health engineering and account management teams to troubleshoot dashboard synchronization issues, identify reporting discrepancies, and advocate for necessary system updates.
- Build and refine weekly and monthly management checklists to track active clinical enrollments through final month-end claim sign-offs with zero variance.
- Create and update revenue-cycle dashboards for Vayu’s finance and accounting team.
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