Job Title: Revenue Cycle Operations SME
Location: Remote
Job Description:
RCM Functional SME – Backend PFS ***Remote with travel***
About the role
You'll thrive in this role if you have a thorough working knowledge of backend PFS billing, denials, and AR follow-up from a business perspective, and you're excited to work directly with our engineering team as we apply AI to these processes.
We're building AI tools to take on backend Patient Financial Services work: billing, denial management, AR follow-up, underpayment identification, payment posting/reconciliation, and self-pay AR follow-up. Our engineers can build the technical solutions; this role supplies the operational depth so the tools get built against how the work actually gets done.
What you'll do
• Partner directly with our engineering team to translate real desk-level workflows into system logic: what a denial specialist checks before deciding to appeal versus write off, how an AR rep prioritizes a work queue, how an underpayment gets flagged and disputed, how self-pay balances get tracked toward payment plan or bad debt
• Answer the engineering team's questions about how billing and AR decisions actually get made, including payer policies, contract terms, denial code mappings, timely filing rules, and escalation thresholds
• Help build a reference library (policies, templates, procedures) the AI can pull from
• Write up how you do the job today, in a way that can be turned into clear rules and instructions
• Review AI-drafted output (appeal drafts, dispute packages, classification decisions) for accuracy against how a real specialist would handle the account
• Define what "good" looks like for each workflow, including the judgment calls a supervisor would make, the edge cases that need a human, and the dollar or risk thresholds that should trigger review
• Flag gaps between the system's proposed logic and actual operational practice as builds iterate
• Join working sessions, demos, and pressure-testing sessions as the build progresses
Experience:
• Team lead or supervisor-level experience (minimum) in backend PFS: denials, AR follow-up, underpayment identification, payment posting/reconciliation, or claims/billing
• Working fluency in CARC/RARC denial codes, payer contract and fee schedule terms, timely filing and appeal deadlines, 835/837 remittance data, AR aging and collection probability, write-off versus adjustment classification, credit balance resolution and refunds, and coordination of benefits (COB)
• Understanding of upstream billing and claims concepts that affect backend outcomes: 271 eligibility responses, 277CA claim acknowledgments, claim holds and edits, clearinghouse rejections, and how a missed edit upstream turns into a downstream denial
• Understanding of self-pay AR follow-up: statement cycles, payment plan tracking, and bad debt classification (back-office tracking, not patient-facing collections)
• Familiarity with major EHRs (Epic, Oracle Health/Cerner, Meditech, Athena) and how PFS work queues function within them
• An in-depth understanding of the knowledge and data used to make decisions in patient financial services / patient accounting
• Ability to review AI-generated work product and judge it the way a supervisor would judge a team member's work
• US-based, ability to travel
• Prior exposure to RCM automation or transformation initiatives is a plus, not a requirement
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