# RCM Workflow Specialist

**Company:** [Joyful Health](https://hotfix.jobs/companies/joyful-health)
**Location:** New York, NY, New York
**Role:** Other
**Experience:** 5+ years
**Skills:** Medical Billing, A/R Management, Denials Resolution, Payer Portals, Carc/Rarc Codes, AI Tools, Claims Workflows, Eligibility Systems
**Posted:** 2026-04-23

> Reviews and labels AI agent decisions on healthcare claims, performs expert-level RCM workflows including denials and A/R, and collaborates with engineering to improve product features. Requires 5+ years hands-on billing experience and AI tool usage.

## Job Description

## 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

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