Revenue Cycle Claims Specialist

Finni Health Inc.

Job Overview

Location

US Remote

Job Type

Full-time

Full Job Description

📋 Description

• Serve as an Individual Contributor in Revenue Cycle Management (RCM) to optimize claims processing and revenue collection for Finni Health’s autism care providers.
• Triaging claims by monitoring deadlines and proactively alerting the RCM team to claims approaching timely filing limits, ensuring timely submission and minimizing revenue loss.
• Resolve payer rejections by investigating root causes, contacting payers directly, and securing acceptance of claims through accurate corrections and documentation.
• Follow up on claims with no payer response to confirm receipt and ensure claims remain on file, preventing delays in payment.
• Address claims held due to eligibility issues by identifying the source of coverage gaps and coordinating with internal teams to obtain updated insurance information.
• Research and appeal claim denials within payer-specified deadlines, gathering necessary documentation and communicating with payers to reverse improper denials.
• Manage payer EDI enrollments including ERA (Electronic Remittance Advice) and EFT (Electronic Funds Transfer) setups, troubleshooting missing ERAs and enrolling new payers as they join the network.
• Ensure strict compliance with payer regulations, CMS billing guidelines, NCQA standards, and internal RCM policies across all claims and billing activities.
• Lead operational improvement initiatives within RCM by identifying inefficiencies, designing streamlined workflows, and implementing process enhancements to reduce denials and accelerate cash flow.
• Contribute to the development and execution of RCM strategy, including billing protocols, claims processing standards, revenue collection procedures, and cash posting accuracy.
• Collaborate cross-functionally with Product, Provider Success, Compliance, HR, and Finance teams to align RCM operations with company-wide goals and provider support needs.
• Adapt to evolving responsibilities as Finni Health scales, taking on new projects and adjusting workflows in response to changes in the RCM landscape and business priorities.
• Utilize EHR/RCM management tools and work queue systems to track, prioritize, and resolve claims efficiently within a high-volume, fast-paced environment.
• Maintain high standards of accuracy and timeliness in all RCM functions while contributing to a culture of continuous improvement and financial accountability.

🎯 Requirements

• 5+ years of experience in revenue cycle management, RCM operations, or related healthcare finance roles
• Deep understanding of full revenue cycle processes including billing, claims processing, collections, denial appeals, and accounts receivable management
• Proven experience resolving payer rejections and denials through direct payer communication and documentation
• Proficiency with EHR/RCM management tools and EMR work queue systems
• Strong knowledge of CMS billing guidelines, NCQA standards, and healthcare compliance requirements
• Demonstrated ability to drive process improvements and operational efficiency in a fast-paced environment

🏖️ Benefits

• Opportunity to work remotely across the United States
• Join a rapidly growing healthcare startup backed by General Catalyst and YCombinator
• Impactful mission to democratize autism care and empower providers through robust RCM systems
• Collaborative, dynamic environment with cross-functional exposure to Product, Compliance, and Provider Success teams

Skills & Technologies

Remote

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Finni Health Inc.

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About Finni Health Inc.

Finni Health is a healthcare technology company that provides insurance and benefits administration services for employers. It offers a platform that simplifies health plan selection, enrollment, and management for small and medium-sized businesses. The company integrates with existing payroll and HR systems to automate benefits administration, reduce administrative burden, and provide employees with digital tools to understand and use their health benefits.

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