Revenue Cycle Specialist

Overview

This role focuses on managing the revenue cycle with an emphasis on accounts receivable (AR) follow-up, ensuring claims are processed efficiently, resolving cash flow issues, and collaborating with providers to handle denials and rejections. The position requires fluency in prior authorization (PA) processes, including understanding the distinctions between medical and pharmacy benefits and handling complex PA tasks as needed.

The organization supports over 1,000 independent psychiatry practices nationwide, providing specialized electronic health records (EHR), software solutions, and managed services to improve psychiatric care delivery and research.

Responsibilities

• Manage the cash side of the revenue cycle by ensuring clean claims are submitted without bottlenecks and addressing holds, edits, and rejections.
• Work outstanding AR across 30/60/90+ day aging buckets, prioritize high-dollar claims, and resolve denials, rejections, and holds to maximize cash flow.
• Collaborate directly with providers to gather information, resolve denial issues, and prevent recurring denial patterns.
• Navigate billing for modern Evaluation & Management (E&M) services and telehealth, including understanding place of service (POS) rules and state- and payer-specific telehealth modifiers.
• Provide support for prior authorizations, including medical vs. pharmacy benefit routing, pharmacy benefit managers (PBMs), buy-and-bill versus specialty pharmacy procurement, and coordinating peer-to-peer reviews when necessary.
• Conduct quality improvement activities such as auditing and cleaning AR backlog, identifying template, standard operating procedure (SOP), and workflow improvements.
• Communicate clearly and professionally with providers, ensuring messages are actionable without need for follow-up.
• Proactively raise internal blockers and issues promptly within appropriate channels.

Requirements

• Minimum 3 years of hands-on experience in AR resolution, including managing denials, rejections, appeals, and prioritizing claims to maximize cash flow.
• Prior authorization experience with responsibilities such as requesting, amending, and following PAs through to resolution; experience with appeals or peer-to-peer coordination is a plus.
• Strong understanding of benefit routing, including medical vs. pharmacy benefits, PBMs, and distinctions between buy-and-bill and specialty pharmacy procurement.
• Proficiency in modern E&M and telehealth billing, including familiarity with POS rules and telehealth modifier complexities.
• Ability to quickly learn and adapt to new technology platforms without formal training.
• Experience with major payer portals such as Availity, Navinet, PayerCompass, or other payer-specific portals.
• Daily use of AI tools (e.g., Claude, Gemini) to enhance workflow and problem-solving.
• Comfortable working in a fast-paced, startup-like environment with ownership and process improvement opportunities.
• Open and direct communication style, able to raise blockers quickly and provide clear feedback.
• Must be based in the United States and eligible to work without sponsorship.

Preferred Qualifications

• Experience with specialty billing in interventional psychiatry (e.g., TMS, Spravato, ketamine), oncology, infusion, immunology, or other high-cost drug specialties.
• Familiarity with Candid Health.
• Experience using PA-requesting platforms such as CoverMyMeds or Spravato withMe.
• Proficiency with collaboration and documentation tools like Notion, Slack, and Pylon.
• Previous experience working in startup or scale-up environments.

Compensation & Benefits

This is a full-time, remote W-2 position open to candidates anywhere in the United States. Specific compensation details are not provided.

Application Instructions

Applicants should include a brief response (4–6 sentences) describing a recent denial type, payer policy quirk, or prior authorization hurdle they have encountered. The response should specify the payer, CPT/HCPCS code or drug involved, the denial reason or policy hurdle, initial unsuccessful attempts to resolve it, and the eventual resolution. This helps assess communication skills and problem-solving approach.