[Hiring] RCM Revenue Cycle Specialist @Medzed LLC

Role Description

The Revenue Cycle Specialist is responsible for protecting MedZed’s cash flow by ensuring timely authorization, clean claim submission, and full reimbursement across our health plan portfolio. This role owns day-to-day billing operations, denial resolution, and payer communications, and contributes data and insights that inform broader revenue cycle strategy. The ideal candidate brings hands-on Medi-Cal managed care billing experience and thrives in a fast-paced, operationally complex environment where accuracy and follow-through directly impact the business.

Key Responsibilities

• Authorization Management: Own the full prior authorization lifecycle across MedZed’s health plan partners, from initial submission through status monitoring, follow-up, and escalation. Maintain working knowledge of each payer’s authorization requirements, turnaround expectations, and portal workflows to prevent lapses that delay reimbursement.
• Claims Submission & Denial Resolution: Prepare and submit clean claims in accordance with payer-specific requirements for encounter-based and PMPM contracts. Investigate rejected and denied claims by identifying root causes, executing corrective resubmissions, and tracking resolution through payment. Own aging AR follow-up with a focus on reducing days in AR and minimizing write-offs.
• Payer Relationship & Reconciliation Support: Serve as a day-to-day operational contact for billing-related payer communications. Support reconciliation efforts by flagging discrepancies in member-month counts, encounter submissions, or payment variances, and escalate unresolved items to the Revenue Cycle Manager.
• Trend Analysis & Process Improvement: Monitor denial patterns, authorization delays, and payment trends across the payer portfolio. Surface systemic issues to leadership with supporting data. Contribute to workflow improvements aimed at reducing denial rates, accelerating reimbursement cycles, and tightening documentation standards.
• Documentation & Compliance: Maintain accurate, auditable records of all authorization, billing, and follow-up activities within MedZed’s revenue cycle and EHR systems. Stay current on Medi-Cal billing rules, CalAIM program requirements, and managed care contract terms that affect claim eligibility and reimbursement.

Qualifications

• Minimum 2 years of experience in revenue cycle management, with direct involvement in billing, prior authorization, and/or denial management.
• Experience with Medi-Cal managed care billing, including familiarity with encounter-based reimbursement models and health plan portals.
• Strong understanding of claim submission workflows, denial root cause analysis, and payer-specific requirements.
• Intermediate-to-advanced Excel skills, including comfort with data exports, pivot tables, and reconciliation spreadsheets.
• Proficiency with revenue cycle systems, EHR platforms, and CRM tools (e.g., Salesforce).
• Excellent written and verbal communication skills, with the ability to work cross-functionally across Finance, Operations, and Clinical teams.
• Ability to manage multiple priorities and meet deadlines in a fast-paced, high-growth environment.

What Success Looks Like

• First 90 Days: Fully onboarded to all payer portals and submission workflows. Independently managing authorization requests and claim submissions with minimal supervision. Baseline understanding of MedZed’s contract structures and payer-specific requirements.
• 6 Months: Measurable reduction in denial rates and days in AR. Proactively surfacing trends and contributing to process improvements. Trusted point of contact for payer billing communications.
• 12 Months: Clean claim rate consistently above 95%. Reconciliation discrepancies flagged and resolved within established SLAs. Recognized as a subject matter expert on MedZed’s payer billing requirements.