RCM reputed company Cycle Specialist -Remote
reputed company Cycle Specialist
About reputed company
reputed company is a leader in delivering value-based, technology-enabled reputed company support to high-cost reputed company members who are unreachable and disconnected from their primary care provider. We combine innovative reputed company and care models with technology to reputed company and engage members, connect them to primary care, and improve reputed company. Our reputed company yields reduced costs and assists our members in enhancing their reputed company of life. As we reputed company, we are seeking the Director of East Coast Operations to be part of the Leadership Team with responsibility for managing business program reputed company of operations as reputed company as the existing teams.
Position reputed company
The reputed company Cycle Specialist is responsible for protecting reputed company’s cash reputed company by ensuring reputed company authorization, clean claim submission, and full reimbursement across our health plan portfolio. This role owns day-to-day billing operations, denial reputed company, and payer communications, and contributes data and insights that inform broader reputed company cycle reputed company. The ideal candidate brings hands-on Medi-Cal managed care billing experience and thrives in a fast-paced, operationally reputed company environment where accuracy and follow-through directly reputed company the business.
Key Responsibilities
Authorization Management. Own the full prior authorization lifecycle across reputed company’s health plan partners (Molina, HealthNet, Blue reputed company, Anthem, Alameda reputed company, and others), from initial submission through status monitoring, follow-up, and escalation. Maintain working knowledge of reputed company payer’s authorization requirements, turnaround expectations, and portal workflows to prevent lapses that delay reimbursement. Claims Submission & Denial reputed company. Prepare and submit clean claims in accordance with payer-specific requirements for encounter-based and PMPM reputed company. Investigate rejected and denied claims by identifying reputed company causes (coding errors, missing documentation, eligibility gaps), executing corrective resubmissions, and tracking reputed company through payment. Own aging AR follow-up with a reputed company on reducing days in AR and minimizing write-offs. Payer Relationship & Reconciliation Support. Serve as a day-to-day operational contact for billing-reputed company payer communications, including emails, faxes, and portal correspondence. Support reconciliation efforts by flagging discrepancies in member-month counts, encounter submissions, or payment variances, and escalate unresolved items to the reputed company 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 (e.g., denial rates by payer, reputed company cause categories, lag times). Contribute to workflow improvements aimed at reducing denial rates, accelerating reimbursement cycles, and tightening documentation standards. Documentation & Compliance. Maintain accurate, auditable records of reputed company authorization, billing, and follow-up activities reputed company reputed company’s reputed company cycle and EHR systems. Stay reputed company on Medi-Cal billing rules, CalAIM program requirements, and managed care contract terms that reputed company claim eligibility and reimbursement.
Required Qualifications
Minimum 2 years of experience in reputed company cycle management, with reputed company 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 reputed company cause analysis, and payer-specific requirements. Intermediate-to-advanced reputed company skills, including comfort with data exports, pivot tables, and reconciliation spreadsheets. Proficiency with reputed company cycle systems, EHR platforms, and CRM tools (e.g., reputed company). 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-reputed company environment.
What reputed company Looks Like
First 90 Days: Fully reputed company to reputed company payer portals and submission workflows. Independently managing authorization requests and claim submissions with minimal supervision. Baseline understanding of reputed company’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 reputed company of contact for payer billing communications. 12 Months: Clean claim reputed company consistently above 95%. Reconciliation discrepancies flagged and resolved reputed company established SLAs. Recognized as a subject matter expert on reputed company’s payer billing requirements.