Revenue Cycle Claims Specialist

Finni Health empowers autism care providers to start, run, and grow their own practices. We democratize autism care by providing access to our insurance network, purpose-built EHR software, HR solutions, and clinical support. We've experienced rapid growth and are backed by top-tier investors like General Catalyst and YCombinator. We seek smart, driven individuals eager to innovate in a dynamic, fast-paced environment.

As a Revenue Cycle Claims Specialist (Individual Contributor), you will play a critical role in optimizing our revenue cycle operations. Your primary responsibilities will include:

• Claims Triaging

  • Timely Filing - Monitor claims approaching timely filing limits and alert the RCM team about these claims, and work collaboratively to resolve and send the billing claims.

  • Payer Rejections - Resolve payer claims rejections by researching the root cause, calling the payer, and ultimately getting claims accepted by the payer.

  • No Response - Follow up on claims with no payer response and ensure claims are on file with payers.

  • Claims Held due to Eligibility - Identify root cause of issues and work with various teams to obtain updated coverage information as necessary.

• Claim Denials: Research root cause of denials, contact payers for additional information/clarification if necessary, and appeal claim denials within the appeal deadline windows.

• Payer EDI Enrollments Management: Ensure all EDI-related enrollments (ERA, EFT) are in place with payers, troubleshoot issues as needed (missing ERAs), and enroll as new payers become in-network.

• Compliance and Quality Assurance: Ensure strict adherence to payer regulations, industry standards (e.g., CMS billing, NCQA Guidelines, Delegated Credentialing), and internal policies, maintaining high service and compliance standards across all RCM functions.

• Operational Efficiency and Project Management: Lead workflow optimization initiatives within RCM, manage specific projects, and drive continuous process improvements to maximize reimbursement and minimize denials.

• RCM Strategy & Execution: Contribute to the development and implementation of effective processes for billing, claims processing, revenue collections, and cash posting, ensuring accuracy and timeliness.

• Cross-Functional Collaboration: Collaborate extensively with product, provider success, compliance, HR, finance, and other teams to align RCM efforts with overall business objectives and drive strategic goals.

• Additional Responsibilities: Adapt and take on evolving responsibilities and projects as Finni Health grows and the RCM landscape changes.

You are a proactive and collaborative individual contributor with a strong background in revenue cycle management, driven by a commitment to operational excellence and financial performance.

• Experience: 5+ years of relevant experience in revenue cycle management, RCM operations, or related roles, preferably in an early-stage startup, behavioral or mental health, or healthcare tech. Strong understanding of RCM processes, including billing, claims, collections, denial appeals, and accounts receivable management.

• Collaborative & Independent Contribution: Proven ability to work effectively within a team environment, contributing to collective success, and independently driving RCM initiatives.

• RCM Expertise: Deep understanding of the full revenue cycle, including billing, claims processing, collections, accounts receivable management, payer contracting, and compliance (e.g., CMS billing).

• Analytical & Problem-Solving: Strong ability to analyze complex RCM data, identify trends, root causes of issues, and implement effective, data-driven solutions to optimize financial performance.

• Process Optimization: Demonstrated expertise in identifying inefficiencies and driving process improvements for RCM efficiency and effectiveness.

• Communication & Collaboration: Excellent written and verbal communication skills, with proven ability to effectively collaborate with internal teams and external stakeholders (payers, vendors, providers).

• Organizational & Time Management: Exceptional organizational and time management skills, with the ability to manage multiple priorities and projects in a fast-paced environment.

• Tech Proficiency: Proficient in Google Suite, Slack, CRM/support software, and EHR/RCM management tools. Experience with various EMR/EHR work queue management within RCM is a plus.

• Mission Alignment: Passion for Finni’s mission to democratize autism care and empower providers through robust RCM.

• Adaptability & Agility: Comfortable thriving in a dynamic, fast-paced startup environment, embracing change, and navigating ambiguity with a proactive mindset.

Ready to make a significant impact at a rapidly growing healthcare startup? We'd love to hear from you!