RCM Workflow Specialist

Responsibilities

Execute High-Quality Claims Workflows

• Work claims across denial, A/R, and follow-up workflows with a focus on accuracy and decision quality — not volume
• Perform investigation, correction, and resolution of claims
• Interact with payer systems, portals, and call centers as needed
• Get creative when standard paths don’t work — you find a way to get the claim resolved

Review and Label Agent Decisions

• Review a statistical sample of AI agent–closed encounters each week and assess whether the agent’s action was correct, with a written rationale
• Provide natural language corrections through the product interface
• Flag patterns in where the agent consistently struggles or makes avoidable errors
• Make confident calls on ambiguous scenarios

Structure Data Through Labeling

• Translate claim activity into standardized, structured workflow outputs
• Accurately label denial categories and CARC/RARC codes, root cause reasoning, recovery actions taken, outcomes (paid, denied, written off, appealed, etc.)
• Ensure every claim worked and every agent review produces clean, structured data

Partner Directly with Product & Engineering

• Work alongside engineers in a fast-moving, collaborative environment
• Tell us when something is wrong — if a proposed workflow doesn’t reflect how billing actually works, say so clearly and explain why
• Help validate whether features and agent behaviors reflect real-world RCM operations before they are released
• Act as the voice of the RCM practitioner in product development
• Leverage AI tools actively in your work

Identify Patterns & Surface Insights

• Recognize trends across claims, payers, and denial types
• Flag inconsistencies, contradictions, or unclear outcomes
• Surface edge cases and breakdowns in workflows
• Contribute to improving categorization logic, definitions, and SOP quality