RCM Revenue Cycle Specialist -Remote at MEDZED GROUP

Santa Rosa, California, United States -

Full Time

Start Date

Immediate

Expiry Date

19 Jun, 26

Salary

65000.0

Posted On

21 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Authorization Management, Claim Submission, Denial Resolution, Payer Communications, Medi-Cal Managed Care Billing, Root Cause Analysis, AR Follow-up, Data Analysis, Process Improvement, Documentation, Excel, EHR Platforms, CRM Tools, Communication Skills

Industry

Hospitals and Health Care

Description

REVENUE CYCLE SPECIALIST Position Title: Revenue Cycle Specialist Department: Finance & Revenue Operations Reports To: Revenue Cycle Manager Location: Remote Employment Type: Full-time Travel Requirement: n/a ABOUT MEDZED MEDZED IS A LEADER IN DELIVERING VALUE-BASED, TECHNOLOGY-ENABLED SOCIAL SUPPORT TO HIGH-COST MEDICAID MEMBERS WHO ARE UNREACHABLE AND DISCONNECTED FROM THEIR PRIMARY CARE PROVIDER. WE COMBINE INNOVATIVE OUTREACH AND CARE MODELS WITH TECHNOLOGY TO FIND AND ENGAGE MEMBERS, CONNECT THEM TO PRIMARY CARE, AND IMPROVE OUTCOMES. OUR INTERVENTION YIELDS REDUCED COSTS AND ASSISTS OUR MEMBERS IN ENHANCING THEIR QUALITY OF LIFE. AS WE SCALE, WE ARE SEEKING THE DIRECTOR OF EAST COAST OPERATIONS TO BE PART OF THE LEADERSHIP TEAM WITH RESPONSIBILITY FOR MANAGING BUSINESS PROGRAM GROWTH OF OPERATIONS AS WELL AS THE EXISTING TEAMS. POSITION OVERVIEW 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 (Molina, HealthNet, Blue Shield, Anthem, Alameda Alliance, and others), 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 (coding errors, missing documentation, eligibility gaps), 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, 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 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 (e.g., denial rates by payer, root 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 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. REQUIRED 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.

Responsibilities

The Revenue Cycle Specialist is responsible for protecting cash flow by ensuring timely authorization, clean claim submission, and full reimbursement across the health plan portfolio. This role manages daily billing operations, denial resolution, and payer communications while providing data insights for revenue cycle strategy.