Revenue Cycle Claims Specialist

About Finni Health 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. What You Will Be Doing: As an 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 claims for billing. Payer Rejections - Resolve payer claims rejections by researching the root cause, calling the payer, and ultimately get 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, contacts payers for additional information/clarification if necessary, and appeal claim denials within 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. About You: 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!

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