[Hiring] Revenue Cycle Claims Specialist @Finni Health

Role Description

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: Monitor claims approaching timely filing limits and alert the RCM team about these claims and work collaboratively to resolve and send the claims for billing.
• Payer Rejections: Resolve payer claims rejections by researching the root cause, calling the payer, and ultimately get claims accepted by the payer.
• No Response: Follow up on claims with no payer response and ensure claims are on file with payers.
• Claims Held due to Eligibility: Identify root cause of issues and work with various teams to obtain updated coverage information as necessary.
• Claim Denials: Research root cause of denials, contact payers for additional information/clarification if necessary, and appeal claim denials within appeal deadline windows.
• Payer EDI Enrollments Management: 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.
• Compliance and Quality Assurance: 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.
• Operational Efficiency and Project Management: Lead workflow optimization initiatives within RCM, manage specific projects, and drive continuous process improvements to maximize reimbursement and minimize denials.
• RCM Strategy & Execution: Contribute to the development and implementation of effective processes for billing, claims processing, revenue collections, and cash posting, ensuring accuracy and timeliness.
• Cross-Functional Collaboration: Collaborate extensively with product, provider success, compliance, HR, finance, and other teams to align RCM efforts with overall business objectives and drive strategic goals.
• Additional Responsibilities: Adapt and take on evolving responsibilities and projects as Finni Health grows and the RCM landscape changes.

Qualifications

• 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, contributing to collective success, and independently driving 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. Experience with various EMR/EHR work queue management within RCM is a plus.
• 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.

Benefits

• Ready to make a significant impact at a rapidly growing healthcare startup? We'd love to hear from you!