Revenue Cycle Operations Specialist

UpsideHom, Inc.•Fort Lauderdale, FL

3h•$65,000 - $75,000•Remote

About The Position

Upside is hiring a Revenue Cycle Operations Specialist to support the full claims lifecycle across multiple Medicaid managed care plans. This role sits at the intersection of service delivery, payer billing, and revenue operations, helping ensure eligible services are billed accurately, claims are submitted on time, and revenue gaps are identified and resolved quickly. This is a detail-heavy, operational role for someone who understands how Medicaid billing works in the real world: payer-specific rules, authorization windows, claim edits, denials, billing frequencies, and month-end reconciliation. You’ll work primarily in Salesforce, payer/member portals, and Stedi, our electronic claims platform, to monitor claim readiness, resolve issues, and keep revenue cycle workflows moving across multiple programs and states.

Requirements

2+ years of experience in medical billing, claims operations, or revenue cycle management, ideally in a Medicaid or managed care environment
Hands-on experience working with claims, denials, eligibility, authorizations, payment follow-up, or month-end revenue cycle workflows
Strong understanding of Medicaid managed care billing, including payer-specific rules, claim submission requirements, and reimbursement timelines
Familiarity with HCPCS Level II procedure codes, ICD-10-CM diagnosis coding, and Z-codes for SDOH-related services
Working knowledge of CMS-1500 claims and how procedure codes, modifiers, diagnosis codes, authorizations, and service documentation connect in the billing process
Comfort reviewing claim and denial codes, identifying patterns, and escalating issues with clear context
Experience working across multiple payers, plans, states, or contract requirements at the same time
Strong attention to detail and comfort managing high-volume lists, reports, and follow-ups without letting items slip through the cracks
Proficiency in spreadsheets and comfort working across multiple systems; Salesforce experience is a strong plus
Experience with clearinghouses, payer portals, or claims platforms; Stedi experience is a plus
Ability to work independently, prioritize competing deadlines, and escalate issues appropriately

Nice To Haves

Familiarity with prior authorization, eligibility verification, housing-related services, long-term care transition programs, or SDOH billing is a plus

Responsibilities

Manage day-to-day revenue cycle operations across multiple Medicaid managed care plans, including claim readiness, submission tracking, denial follow-up, payment posting, and reconciliation
Monitor eligible service events and identify missing, unbilled, or underbilled claims to help close revenue gaps
Review payer-specific billing rules, fee schedules, authorization requirements, billing frequencies, and contract terms to ensure claims are submitted accurately
Track claim status across Stedi, Salesforce, payer portals, and internal reports
Identify and resolve claim edits, rejections, denials, and payment issues; draft and submit appeals or corrected claims as needed
Review denial codes and claim trends to understand root causes and flag recurring issues to leadership
Partner with Operations and service delivery teams to ensure member records, authorizations, service documentation, and billing inputs support clean claims
Monitor for issues that may prevent billing, including expired authorizations, eligibility gaps, missing documentation, or services that do not meet payer rules
Support weekly and monthly billing workflows, including payer-specific claim cycles, month-end close, aging review, and collections reporting
Validate procedure codes, modifiers, diagnosis codes, and billing rules against Medicaid managed care plan requirements
Maintain clean, accurate tracking of claims activity, denials, payments, and open revenue cycle follow-ups
Help improve revenue cycle processes as Upside scales across new programs, states, and payer contracts