RCM Workflow Specialist

About the role

The healthcare payment system is a complex and inefficient maze. Healthcare practices leave $125 billion in revenue uncollected each year, lost in the chaos of fragmented financial data, manual workflows, and opaque payer systems. This financial uncertainty leaves practices struggling to stay afloat while valuable revenue slips through the cracks. Joyful Health is building an AI-powered financial operating system for healthcare practices. Our mission is to bring the joy back to running a private practice by simplifying financial operations so providers can focus on patient care.

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. There is no such thing as “we can’t do it.”

• 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 for your decision
  • Provide natural language corrections through the product interface (e.g., “We should have checked the payer portal before closing — there was a timely filing issue that needed a retro authorization”)
  • These corrections feed directly into model training — your expertise is what makes the system smarter
  • Flag patterns in where the agent consistently struggles or makes avoidable errors
  • Make confident calls on ambiguous scenarios — many of these are judgment calls, and sitting on the fence is not an option

• 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.)

  • Partner Directly with Product & Engineering

    • Work alongside engineers in a fast-moving, collaborative environment — engineers communicate directly and get to the point quickly; you need to be comfortable in that environment and able to hold your own on RCM expertise
    • 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 — you are shaping how the system thinks, not just reviewing what it does
    • Leverage AI tools actively in your work — we expect everyone on this team to be pushing the boundary of what’s possible with the tooling available to them

  • 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

  How You’ll Be Measured

  • This role is measured on quality, not quantity. Throughput is not a primary metric — the goal is expert-level accuracy and meaningful insight generation.

  • Accuracy of data labels and agent QA decisions

  • Quality and confidence of rationale provided for ambiguous cases

  • Quality and specificity of product feedback — not just “this is broken” but “here’s why and here’s what should happen instead”

  • Consistency of workflow execution

  • Signal contribution to product and model improvements — measurable instances where your feedback changed something for the better

  • Independence and confidence on judgment calls — a key marker of success is that you don’t need to escalate ambiguous cases — you make a call and explain it

  What Success Looks Like

  • In 30 Days

    • Deep familiarity with Joyful workflows, the product interface, and labeling structure
    • Producing accurate, well-reasoned claim documentation and agent QA labels
    • Comfortable navigating payer systems and making independent decisions on clear-cut cases
    • Establishing a working relationship with the Engineering team — communication style calibrated, expectations clear

  • In 90 Days

    • Independently working claims and QA-ing agent decisions across multiple denial categories
    • Consistently producing high-quality labeled data with clear, confident rationale
    • Actively identifying patterns and surfacing them as actionable insights — not just flagging problems
    • Comfortable making confident calls on ambiguous cases with minimal escalation
    • Feedback from Engineering that your product input is changing how they think about features

  • In 6–12 Months

    • Recognized as a trusted RCM expert within the CoE — the person Engineering and the RCM Architect team go to when something is hard
    • Your corrections and labels have meaningfully improved agent performance — measurable reduction in agent errors in the categories you’ve been reviewing
    • Contributing to the evolution of workflow definitions, SOPs, and labeling logic
    • Operating at the frontier of what’s possible with AI-assisted billing — actively exploring where the system can do more

  We'd Love to Hear From You

  • If you have 5+ years of experience in medical billing, A/R, or denials with hands-on, claim-level expertise
  • Deep familiarity with payer portals, eligibility systems, and denial resolution workflows
  • Experience working claims across denial categories and navigating ambiguous payer decisions
  • Experience with specialties like ABA, behavioral health, or complex billing environments (preferred but not required)
  • A track record of using AI tools, automation, or technology to work smarter — this is a non-negotiable
  • You are a relentless problem-solver on denials — there is no claim you won’t find a way to resolve
  • You are confident on judgment calls — when a case is ambiguous, you make a call and explain your reasoning. You don’t default to “maybe” when you mean “no.”
  • You are willing to push back — you don’t accept “that’s how we’ve always done it” at face value
  • You are comfortable with engineers — engineering communication is direct, fast, and sometimes feels confrontational — but it’s really just about getting to the truth quickly
  • You are detail-obsessed — you care about getting things exactly right, and your documentation reflects it
  • You are systems-oriented — you notice patterns across claims, not just individual cases. You’re thinking about what’s causing a category of problem, not just fixing one instance
  • You are curious about why — you want to understand why something happened, not just resolve it and move on
  • You are a clear communicator across audiences — you can write a correction that an engineer can implement, a recommendation that an RCSM can act on, and an SOP that a biller can follow. These are different things, and you know the difference
  • You are open to iteration — you approach your own processes with the same curiosity you bring to claims