RCM Functional SME

RCM Functional SME

New York NY - (Remote/Travel Ones in A Month)

W2 Candidates

Onsite Interview 2 rounds

Must have required skills - RCM Automation (Revenue Cycle Management) Backend Patient Financial Services (PFS) Expertise AR Follow-Up & Revenue Recovery Healthcare Revenue Cycle Data & Transaction Knowledge Process Translation Automation & AI Review

Primary Skill Required for the Role:

Youll thrive in this role if you have a thorough working knowledge of backend PFS billing denials and AR follow-up from a business perspective and youre excited to work directly with our engineering team as we apply AI to these processes.

Were building AI tools to take on backend Patient Financial Services work: billing denial management AR follow-up underpayment identification payment posting/reconciliation and self-pay AR follow-up. Our engineers can build the technical solutions; this role supplies the operational depth so the tools get built against how the work actually gets done.

What youll do

Partner directly with our engineering team to translate real desk-level workflows into system logic: what a denial specialist checks before deciding to appeal versus write off how an AR rep prioritizes a work queue how an underpayment gets flagged and disputed how self-pay balances get tracked toward payment plan or bad debt

Answer the engineering teams questions about how billing and AR decisions actually get made including payer policies contract terms denial code mappings timely filing rules and escalation thresholds

Help build a reference library (policies templates procedures) the AI can pull from

Write up how you do the job today in a way that can be turned into clear rules and instructions

Review AI-drafted output (appeal drafts dispute packages classification decisions) for accuracy against how a real specialist would handle the account

Define what good looks like for each workflow including the judgment calls a supervisor would make the edge cases that need a human and the dollar or risk thresholds that should trigger review

Flag gaps between the systems proposed logic and actual operational practice as builds iterate

Join working sessions demos and pressure-testing sessions as the build progresses

Details:

Experience:

Team lead or supervisor-level experience (minimum) in backend PFS: denials AR follow-up underpayment identification payment posting/reconciliation or claims/billing

Working fluency in CARC/RARC denial codes payer contract and fee schedule terms timely filing and appeal deadlines 835/837 remittance data AR aging and collection probability write-off versus adjustment classification credit balance resolution and refunds and coordination of benefits (COB)

Understanding of upstream billing and claims concepts that affect backend outcomes: 271 eligibility responses 277CA claim acknowledgments claim holds and edits clearinghouse rejections and how a missed edit upstream turns into a downstream denial

Understanding of self-pay AR follow-up: statement cycles payment plan tracking and bad debt classification (back-office tracking not patient-facing collections)

Familiarity with major EHRs (Epic Oracle Health/Cerner Meditech Athena) and how PFS work queues function within them

An in-depth understanding of the knowledge and data used to make decisions in patient financial services / patient accounting

Ability to review AI-generated work product and judge it the way a supervisor would judge a team members work

US-based ability to travel

Prior exposure to RCM automation or transformation initiatives is a plus not a requirement

Required Skills:

RCM AutomationBackend Patient Financial ServicesRevenue Cycle ManagementPFS