sprinter-health - Revenue Cycle Specialist
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Requirements
• 3+ years of medical billing experience spanning at least two of the three core functions: AR reconciliation, claim submission/QA, or rejection management • Comfort managing multiple work queues simultaneously and reprioritizing based on aging and volume • Experience working ERA/EOB reconciliation at volume — payer-level batch reconciliation, not just individual claims • Familiarity with 837 claim files, 277 rejection reports, and ERA/835 remittance files • Experience with Medicaid managed care and Medicare Advantage payer requirements • Clearinghouse and RCM platform fluency — experience with leading billing platforms a plus, not required • Experience resolving capitation or encounter-based payment methodology disputes with payers • Prior experience in a lean or startup RCM environment • Exposure to value-based care or risk-adjusted billing models • CMS-1500 and UB-04 experience across both institutional and professional billing
Responsibilities
• AR & Reconciliation (~40% of role): • Reconcile ERA/EOB payments against expected reimbursement; identify and resolve underpayments, overpayments, and missing remittances • Investigate and resolve payment posting flags in the billing system • Maintain AR aging across assigned payer relationships — work buckets by age and priority • Communicate directly with payer representatives to resolve outstanding balance disputes • Coordinate with our RCM platform team on shared AR workqueues — track what the platform owns vs. what is handled internally • Claim Submission & Pre-submission QA (~35% of role): • Perform pre-submission claim scrubbing — catch errors in demographics, eligibility, authorization, coding completeness, and payer-specific requirements before submission • Verify patient eligibility and benefits across assigned payers prior to claim submission • Validate prior authorization requirements and confirm auth numbers are captured correctly on claims • Flag recurring pre-submission error patterns to the RCM Manager with recommendations for upstream workflow fixes • Rejection Resolution (~25% of role): • Resolve claim rejections from our RCM platform and payer portals, including 277 rejection reports and real-time rejection queues • Distinguish between clearinghouse-level fixes and payer-level fixes; coordinate with the platform team accordingly • Maintain a rejection tracking log, tagging by error type, payer, and root cause • Work collaboratively with the Denial Specialists to ensure upstream rejections don't re-enter as downstream denials
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