Insurance

• Monitor and triage claims approaching timely filing limits; coordinate with RCM team to resolve and submit billing
• Research and resolve payer claim rejections; contact payers to get claims accepted
• Follow up on claims with no payer response and ensure claims are on file with payers
• Identify and resolve claims held due to eligibility; obtain updated coverage information as necessary
• Research root causes of denials, contact payers for clarification, and appeal claim denials within appeal deadlines
• Manage payer EDI enrollments (ERA, EFT), troubleshoot missing ERAs, and enroll new payers as they become in-network
• Ensure strict adherence to payer regulations and industry standards (e.g., CMS billing, NCQA Guidelines, Delegated Credentialing)
• Lead workflow optimization initiatives within RCM and manage projects to maximize reimbursement and minimize denials
• Contribute to development and implementation of processes for billing, claims processing, revenue collections, and cash posting
• Collaborate with product, provider success, compliance, HR, finance, and other teams to align RCM efforts with business objectives
• Adapt to evolving responsibilities and projects as Finni Health grows and the RCM landscape changes

Revenue Cycle Claims Specialist

Client Assurance Resolution Leader

Insurance Verification Representative

Field Insurance Inspector

Senior Manager, Insurance Product Analysis

Health Insurance Liaison