Healthrise

• Own end-to-end recruiting for an active portfolio of 15-25 open requisitions across revenue cycle consulting, clinical, coding, and operational roles at any given time. • Partner with hiring managers from intake through offer acceptance; including job scoping, sourcing strategy, candidate review, interview coordination, debrief facilitation, and offer negotiation. • Write and post compelling, accurate, and inclusive job descriptions and postings that reflect the firm’s brand and attract qualified candidates. • Manage candidates with consistent, timely updates and disposition documentation that supports compliance and reporting. • Deliver an exceptional candidate experience from first contact through day one; ensuring every candidate, placed or not, leaves the process with a positive impression of the firm. • Develop and execute multi-channel sourcing strategies using LinkedIn Recruiter, Indeed, professional associations (HFMA, AAPC, AHIMA, MGMA), referral networks, and niche healthcare job boards. • Build and maintain proactive talent pipelines for recurring and hard-to-fill roles including HIM/Coding specialists, RN clinical reviewers, denial management professionals, CDI specialists, and revenue cycle project managers. • Leverage Boolean search, talent mapping, and competitive intelligence to identify passive candidates in the revenue cycle consulting market. • Maintain a network of revenue cycle professionals through consistent outreach, relationship nurturing, and community engagement; converting passive talent into active pipeline. • Collaborate with marketing and leadership on employer branding initiatives, including conference presence, LinkedIn content, employee spotlights, and Glassdoor reputation management.

• Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and judgment within the Hospital and/or Medical Group partner revenue operations. • Serves as part of a team of coding denials resolution specialists responsible for identifying and determining root causes of denials. • Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers. • Promotes departmental awareness of coding best practices.

• Performs day-to-day payment resolution activities within the Hospital and/or Medical Group partner revenue operations. • Scope of responsibility includes all post-billed denials (inclusive of clinical denials). • Serves as part of the Denials Resolution team responsible for ensuring payments are received on denied accounts, determining root causes for discrepancies, minimizing inappropriate payment delays and variances from expected reimbursement, and resolving or escalating issues. • Performs daily activities as part of the payment resolution team that receives, analyzes, and appeals denials. • Reviews, researches, and resolves payment delays and/or variances resulting from rejected and/or denied claims, overpayments, or underpayments. • Processes payments as appropriate in accordance with contracts and policies to ensure timely and accurate liability resolution. • Resolves claims, conducts formal account reviews, identifies lost charge recovery, and analyzes/documents delays and payment variances. • Identifies routine issues and resolves or escalates them as appropriate. • Maintains knowledge of state and federal laws as they relate to contracts and the appeals process. • Investigates and addresses overpayment and underpayment accounts with the goal of optimizing reimbursement. • Coordinates follow-up with clinical departments to provide support for appeals. • Collaborates with Patient Access and other stakeholders to resolve account authorization issues. • Applies knowledge of payer rules, contracts, schedules, and other data sources to resolve payment variances. • Proactively follows up on delays and variances with patients, commercial, Medicare, and Medi-Cal payers to ensure prompt reimbursement, refiles accurate claims, and documents findings. • Contacts insurance carriers and patients as necessary to resolve outstanding balances. • Monitors timely filing limits specific to California payers and ensures all claims are submitted within state and payer deadlines. • Researches payer trends and provides feedback to improve billing accuracy and efficiency. • Tracks and reports denial types and root causes, recommending process improvements. • Analyzes, categorizes, and resolves claim denials from commercial, government, and managed care payers. • Identifies root causes of denials (coding errors, eligibility issues, missing documentation, etc.) and works with clinical and coding teams for resolution. • Files appeals and reconsiderations according to California-specific appeal timelines. • Requests write-offs, transfers, allowances, and reversals as needed. • Recommends accounts for transfer to collection vendors based on complexity and status. • Documents all actions in the patient accounting system. • Responds to patient and payer inquiries or refers them as needed. • Communicates with physicians, office staff, and hospital departments to gather and verify necessary information. • Prepares and submits reports documenting trends, outcomes, and claim activity. • Cross-trains in various functions to enhance service delivery. • Interprets data, draws conclusions, and reviews findings with supervisor. • Continuously learns all aspects of the Denials Resolution Specialist role. • Performs other duties as assigned. Maintains a working knowledge of applicable Federal, State, and local laws/regulations.

• Oversee the day-to-day payment resolution activities of the Denials Resolution team • Perform daily activities related to payment resolution, analyze and appeal denials • Review team members’ work for accuracy and compliance • Track productivity and quality metrics, communicate performance trends • Support onboarding and training of new AR Specialists • Identify recurring issues or payer trends and communicate insights upward • Proactively follow up on delays and variances with patients and payers

• Ability to analyze denial reasons and trends to identify opportunities for process improvement. • Excellent verbal and written communication skills to effectively collaborate with healthcare providers and present appeal arguments. • Keen attention to detail to ensure accurate review and analysis of denied claims and medical records. • Strong problem-solving skills to develop effective appeal strategies and overcome denial challenges. • Understanding of medical terminology, coding principles, and reimbursement guidelines to assess denial reasons and appeal opportunities. • Ability to adapt to changing payer policies, regulations, and reimbursement requirements. • Review denied claims to identify denial reasons and discrepancies. • Analyze medical records, billing documents, and payer policies to prepare appeal arguments. • Collaborate with healthcare providers to gather additional documentation and evidence for appeals. • Document appeal activities, correspondence, and outcomes for tracking and reporting purposes. • Monitor denial trends and provide feedback to revenue cycle teams to prevent future denials. • Participate in denial management meetings and contribute insights to improve denial prevention strategies. • Stay updated on payer policies, regulations, and reimbursement guidelines relevant to claim denials.

• Responsible for day-to-day supervisory oversight and operational execution of technical and coding denial management functions within the Revenue Cycle department. • Lead a team of denial specialists and coordinators focused on resolving technical and coding-related claim denials across all payer types, facilities, and service lines. • Manage daily denial work queues for technical and coding denial categories, ensuring cases are assigned, prioritized by financial impact and deadline risk, and resolved within payer-required timelines. • Monitor team workload, capacity, and throughput on a daily and weekly basis; adjust case assignments and staffing allocation to prevent missed filing deadlines. • Serve as the first-line escalation point for complex technical and coding denial cases that require manager-level review, payer contact, or cross-functional coordination. • Track and report weekly team performance to the Director including denial volumes, appeal activity, resolution rates, write-off risk, and aging by payer, denial code, and category. • Identify systemic denial patterns or payer behavior trends in the queue and escalate to the Director with root cause analysis and recommended corrective actions. • Oversee resolution of technical denials including timely filing, prior authorization, eligibility, coordination of benefits, duplicate billing, medical records requests, and credentialing-related claim rejections. • Review and approve appeal submissions for high-dollar or complex technical denials prior to filing, ensuring accuracy, completeness, and appropriate supporting documentation. • Partner with Patient Access, Provider Enrollment, Utilization Management, and Billing to trace technical denial root causes back to the point of origin and drive sustainable upstream corrections. • Conduct structured root cause analyses on high-volume technical and coding denial categories; present findings and corrective action plans to the Director with supporting denial data.

• Overseeing the Quality Audit (QA) program • Managing QA system access and maintaining accuracy of the staff roster • Leading documentation efforts including SOPs and training materials • Providing leadership to both domestic and global teams • Monitoring the accuracy and completeness of audit results • Developing strategies to enhance audit processes, tools, and outcomes • Overseeing the Atlas QA user access request process • Ensuring documentation is accurate and reflective of current processes • Tracking training rollout and compliance • Communicating with senior leadership and department heads • Facilitating collaboration across domestic and global teams • Providing direct leadership to the domestic quality audit team • Assigning and monitoring workloads • Conducting regular performance reviews and team meetings • Developing team members through coaching and mentoring

• The Cash Posting Auditor within Revenue Cycle Management oversees the accuracy, integrity, and compliance of all cash posting procedures in the revenue cycle department. • This role is responsible for conducting thorough audits, reviews, and analyses of payment posting operations to detect discrepancies, reduce risk, and enhance payment posting and reconciliation processes. • Ensure adherence to internal policies, standard operating procedures (SOPs), and regulatory requirements. • Identify root causes of posting discrepancies or variances and recommend corrective action plans. • Verify balancing accuracy between payments received and posted in financial systems. • Track audit findings, trends, and areas of opportunity; report insights to leadership with recommendations. • Support ongoing improvement initiatives to strengthen the accuracy and timeliness of cash application processes. • Ensure proactive reconciliation and resolution of unapplied or misapplied payments. • Prepare comprehensive audit reports, findings summaries, and recommendations for management review and dissemination and communicate audit results, trends, and insights to stakeholders to facilitate informed decision-making and process improvement efforts. • Collaborate cross-functionally with Cash Posting Representatives, Supervisors, and Revenue Cycle teams to reinforce best practices. • Participate in training and coaching efforts to support quality improvement and compliance. • Performs other duties as assigned by Supervisor or Director.

• Operate, maintain, and optimize Azure infrastructure and platform services in production. • Manage Azure DNS, including API-based DNS automation and lifecycle management. • Administer Azure networking components (vNets, routing, private endpoints, service integration). • Ensure availability, resiliency, and security of Azure-hosted workloads. • Operate and support Azure Kubernetes Services (AKS) clusters in production. • Manage cluster lifecycle, upgrades, node pools, and scaling. • Troubleshoot containerized workloads, networking, and storage within AKS. • Partner with engineering teams to ensure Kubernetes workloads are production-ready. • Serve as a Linux Systems Administrator for Azure-hosted systems and AKS nodes. • Perform provisioning, patching, performance tuning, monitoring, and security hardening. • Operate and support Azure Virtual Desktop environments.

• Performs daily billing activities, including resolving billing edits and rejected claims to ensure accurate and timely claim submission • Identifies routine billing issues and resolves or escalates them as appropriate • Maintains working knowledge of state and federal laws related to insurance contracts and payer billing timelines • Investigates and addresses overpayment and underpayment accounts to optimize reimbursement • Applies payer rules, contracts, schedules, and related data to ensure claims are billed accurately and timely • Researches payer trends and provides feedback to improve billing accuracy and operational efficiency • Tracks and reports denial types and root causes, recommending process improvements • Analyzes, categorizes, and resolves claim rejections from commercial, government, and managed care payers • Documents all actions and follow-up activities in the patient accounting system • Responds to patient and payer inquiries or refers them appropriately • Prepares and submits reports documenting billing trends, outcomes, and claim activity • Interprets data, draws conclusions, and reviews findings with supervisor • Cross-trains in various functions to enhance service delivery • Maintains knowledge of applicable federal, state, and local laws and regulations