• Assist in managing pre-pay and post-pay workflows, including claim editing and recovery processes. • Help define and validate claim edit logic and payment integrity rules to ensure they are functioning correctly for customers. • Perform medical coding audits (inpatient, outpatient, professional) by validating ICD, CPT, HCPCS, and DRG codes under the guidance of senior staff. • Support the customer appeals process by reviewing billed services and assessing their alignment with policies and coding guidelines. • Monitor payer policies and industry benchmarks to identify potential gaps in the current edit library and suggest improvements. • Partner with Product and Engineering teams to assist in testing, troubleshooting, and User Acceptance Testing (UAT) for new and updated rules. • Maintain clear documentation of audit findings and project progress for internal and external stakeholders.

Role Description The Revenue Cycle Specialist is responsible for protecting MedZed’s cash flow by ensuring timely authorization, clean claim submission, and full reimbursement across our health plan portfolio. This role owns day-to-day billing operations, denial resolution, and payer communications, and contributes data and insights that inform broader revenue cycle strategy. The ideal candidate brings hands-on Medi-Cal managed care billing experience and thrives in a fast-paced, operationally complex environment where accuracy and follow-through directly impact the business. Key Responsibilities - Authorization Management: Own the full prior authorization lifecycle across MedZed’s health plan partners, from initial submission through status monitoring, follow-up, and escalation. Maintain working knowledge of each payer’s authorization requirements, turnaround expectations, and portal workflows to prevent lapses that delay reimbursement. - Claims Submission & Denial Resolution: Prepare and submit clean claims in accordance with payer-specific requirements for encounter-based and PMPM contracts. Investigate rejected and denied claims by identifying root causes, executing corrective resubmissions, and tracking resolution through payment. Own aging AR follow-up with a focus on reducing days in AR and minimizing write-offs. - Payer Relationship & Reconciliation Support: Serve as a day-to-day operational contact for billing-related payer communications. Support reconciliation efforts by flagging discrepancies in member-month counts, encounter submissions, or payment variances, and escalate unresolved items to the Revenue Cycle Manager. - Trend Analysis & Process Improvement: Monitor denial patterns, authorization delays, and payment trends across the payer portfolio. Surface systemic issues to leadership with supporting data. Contribute to workflow improvements aimed at reducing denial rates, accelerating reimbursement cycles, and tightening documentation standards. - Documentation & Compliance: Maintain accurate, auditable records of all authorization, billing, and follow-up activities within MedZed’s revenue cycle and EHR systems. Stay current on Medi-Cal billing rules, CalAIM program requirements, and managed care contract terms that affect claim eligibility and reimbursement. Qualifications - Minimum 2 years of experience in revenue cycle management, with direct involvement in billing, prior authorization, and/or denial management. - Experience with Medi-Cal managed care billing, including familiarity with encounter-based reimbursement models and health plan portals. - Strong understanding of claim submission workflows, denial root cause analysis, and payer-specific requirements. - Intermediate-to-advanced Excel skills, including comfort with data exports, pivot tables, and reconciliation spreadsheets. - Proficiency with revenue cycle systems, EHR platforms, and CRM tools (e.g., Salesforce). - Excellent written and verbal communication skills, with the ability to work cross-functionally across Finance, Operations, and Clinical teams. - Ability to manage multiple priorities and meet deadlines in a fast-paced, high-growth environment. What Success Looks Like - First 90 Days: Fully onboarded to all payer portals and submission workflows. Independently managing authorization requests and claim submissions with minimal supervision. Baseline understanding of MedZed’s contract structures and payer-specific requirements. - 6 Months: Measurable reduction in denial rates and days in AR. Proactively surfacing trends and contributing to process improvements. Trusted point of contact for payer billing communications. - 12 Months: Clean claim rate consistently above 95%. Reconciliation discrepancies flagged and resolved within established SLAs. Recognized as a subject matter expert on MedZed’s payer billing requirements.

Position Overview Greater Purpose and Core Values: Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture. Position Summary: Ensures optimum reimbursement and works improve the day-to-day operations of the revenue cycle. Essential Duties and Responsibilities: - Responsible for timely responses to internal and external customers. - Works as part of a multi-departmental team to provide answers to billing inquiries. - Provides a variety of revenue cycle support services in connection to day-to-day operations. - Processes and follows up on payer issues with various entities for completion. - Researches and resolves straightforward account activity. - Provides communication on the methods and principles used for billing to the customers and resolve concerns. - Participates in the flow of the account throughout the revenue cycle process. - Maintains accuracy and integrity of the revenue cycle system and accounts therein. - Collectively works with team to meet organizational targets. Qualifications: - Education: - High school diploma required - Work Experience: - Minimum 1 year of revenue cycle experience preferred - Certification/Licensure: - None required - Knowledge and Technical Skills: - Working knowledge of Revenue Cycle systems - Working knowledge of Microsoft Office - Ability to understand and follow HIPAA regulations Language Skills: - Ability to read, write and speak English proficiently Physical Demands: The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. - Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stoop/kneel/crouch, travel around the office, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding. - Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment: - Consistent with standard office environment, noise level is low with little to no extraordinary environmental factors. Additional Benefits offered with this full-time position: - Medical & Rx, Dental and Vision (eligibility begins day one of employment) - NEW FOR 2025 – KinderCare Discount - NEW FOR 2025 – Headspace for Friends/Family - HSA, Healthcare FSA, Dependent Care FSA - Progyny Fertility Benefit - Critical Illness, Accident, & Hospital Indemnity Insurance - Company Paid Basic Life / AD&D - Supplemental Life Insurance (Employee, Spouse, Child) - Company Paid Short-Term & Long-Term Disability - Company Paid Maternity & Parental Leave - Adoption & Surrogacy Expense Reimbursement - Legal & Credit Monitoring - PTO (accruing starts immediately upon hire) - 6 Major Holidays off plus 2 floating holidays yearly - Physical Therapy/Occupational Therapy benefits as an employee - Bereavement Time Off & Resources - Commuter: Pre-Tax Transit & Parking - Retirement 401(k) w/ Per-Pay Company Match - SoFi Financial Wellness Tools & Loan Resources - HUSK Fitness Resources & Gym Discounts - Home, Auto, and Pet Insurance - Employee Assistance Program (EAP) - Employee Discount Program - Plus more! Learn more by checking out Athletico's Benefits Summary and ID&E Benefits. Athletico provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Salaried ranges listed are for full time (40 hour) employees. Additional pay such as incentive, GAP, overtime, and stipends are subject to the rules of each program and may not be available in all locations. Individual base pay depends on various factors, in addition to primary work location, such as complexity and responsibility of role, job duties/requirements, and relevant experience and skills. Base pay ranges are reviewed and typically updated each year. Offers are made within the base pay range applicable at the time.

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Physician Coder codes and abstracts physician services performed in the hospital setting according to AHA, AMA, guidelines and CMS directives. Must assure data quality through quarterly reviews. Performs data entry of physician services statistics into specialty-specific databases. Works with Medical Records, Finance, and Physician Billing to ensure appropriate flow of information. JOB DUTIES AND RESPONSIBILITIES: - Codes and abstracts professional fee hospital services performed by SLPG physicians from medical records according to ICD-9/ICD-10, CPT-4, HCPCS II, and CMS guidelines. Utilizes 3M Encoder for validation of RVUs and CPT-4 procedure unbundling. - Maintains a 95% coding accuracy rate as measured through quality reviews. - Maintains daily productivity as outlined - Responsible for maintaining up-to-date knowledge of coding guidelines as they relate to physician services for hospital inpatient, observation, consultant, surgical, critical care, and E & M services. - Performs data entry of abstracted physician information into specialty- specific databases. - Conducts educational sessions to the medical staff for coding and documentation compliance. PHYSICAL AND SENSORY REQUIREMENTS: Sitting for up to seven hours per day, three- four at a time. Frequently uses fingers for typing, data entry, etc. Frequent use of hands. Use of upper extremities to rarely lift up to ten pounds. Rarely stoops, bends, or reaches above shoulder level. Hearing as it relates to normal conversation. Seeing as it relates to general vision, near vision, peripheral vision and visual monotony. EDUCATION: RHIA, RHIT, CPC, OR CCS-P with working knowledge of ICD-9/ICD-10, CPT and HCPCS coding required. TRAINING AND EXPERIENCE: Minimum 1-3 years experience in CPT/HCPCS physician procedural coding. Previous experience with computerized patient record and coding system preferred. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.