Healthrise

Auditor

• Conduct audits of AR processes, including payment posting, adjustments, and follow-up activities, to ensure compliance with contracts, policies, and regulatory requirements.
• Analyze, categorize, and resolve claim denials from California commercial, government, and managed care payers.
• Identify root causes of denials, recommend solutions, and support corrective actions to optimize financial performance.
• Plan, execute, and document audits using appropriate methodologies and tools to assess efficiency and integrity of revenue cycle processes.
• Ensure appeals and reconsiderations are submitted according to California payer timelines and regulatory standards.
• Adapt to evolving regulatory changes, technology updates, and organizational priorities.
• Prepare audit reports, summaries, and recommendations for management.
• Communicate findings and trends to stakeholders to support decision-making and process improvement.

AR Auditor

Frontend Engineer

• Support the Manager in overseeing global team operations and daily task execution
• Monitor and track team production
• Support workqueue management and task prioritization
• Conduct audits to ensure quality, accuracy, and compliance
• Provide education and training to global team members
• Collaborate with leadership to update SOPs and implement improvements
• Identify trends, gaps, and opportunities for workflow enhancement
• Prepare and distribute daily, weekly, and monthly performance reports
• Communicate updates and expectations clearly to team members and leadership
• Serve as a support link between global team and domestic leadership
• Foster a positive and collaborative team environment
• Support onboarding and mentoring of new team members
• Assist with special projects as assigned by the Manager

Front End Revenue Cycle Team Lead

Accounts Receivable

• Performs day-to-day payment resolution activities within the Hospital and/or Medical Group partner revenue operations
• Serves as part of the Denials Resolution team responsible for ensuring payments are received on denied accounts
• Determines root causes for discrepancies, minimizing inappropriate payment delays and variances from expected reimbursement, and resolving or escalating issues
• Knows and incorporates Healthrise Core Values
• 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
• Processes payments as appropriate in accordance with contracts and policies
• Resolves claims, conducts formal account reviews, identifies lost charge recovery, and analyzes/document delays
• Investigates and addresses overpayment and underpayment accounts
• Applies knowledge of payer rules, contracts, schedules, and other data sources to resolve payment variances
• Proactively follows up on delays and variances with patients and payers

AR Supervisor

• 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).
• Ensures payments are received on denied accounts, determining root causes for discrepancies.
• Reviews, researches, and resolves payment delays and/or variances resulting from rejected and/or denied claims.
• Processes payments as appropriate in accordance with contracts and policies.
• Resolves claims, conducts formal account reviews, identifies lost charge recovery, and analyzes and documents delays and payment variances.
• Identifies routine issues and resolves 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.
• 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.
• Contacts insurance carriers and patients as necessary to resolve outstanding balances.
• Monitors timely filing limits specific to California payers.
• 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 various payers.
• Identifies root causes of denials 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.

AR Specialist

QA Engineer

• Lead the quality audit program for all team members, identifying trends, gaps, and opportunities for process improvement.
• Partner with domestic and global quality leaders (including the Qodex team) to implement corrective actions and best practices.
• Monitor the accuracy and completeness of audit results, ensuring compliance with standards and client requirements.
• Develop and implement strategies to enhance audit processes, tools, and outcomes.
• Oversee the end-to-end system and portal access request process, ensuring timely submissions, monitoring, and issue resolution.
• Coordinate with client vendor management and access teams to maintain compliance and reduce access delays.
• Lead the creation, updating, and rollout of SOPs, job aids, and training materials to support quality initiatives.
• Ensure documentation is accurate, accessible, and reflective of current processes.
• Track training rollout and compliance to ensure team readiness and knowledge alignment.
• Communicate regularly with senior leadership, department heads, and partner leaders to provide updates, share insights, and align on strategic initiatives.
• Facilitate collaboration across domestic and global teams to promote standardization and continuous improvement.

Manager – QA, Training, Access

Operations

• Establish and lead the Operational Excellence function from the ground up, developing its vision, structure, and long-term roadmap.
• Create and maintain a governance framework for SOPs, work instructions, and training documentation across all RCMS service lines.
• Partner with Operations leaders to ensure readiness for all new client engagements, including documentation, training, and access requirements.
• Serve as a strategic advisor to senior leadership on quality, training, and workforce capability, ensuring these programs align with business goals and client expectations.
• Lead a high-performing team, including leaders and related staff responsible for quality audits, system access, process documentation, and training.
• Oversee the Quality Audit program, ensuring accuracy, consistency, and compliance with client and regulatory requirements.
• Identify performance trends and partner with operational leaders to address gaps through targeted training and process improvements.
• Implement continuous feedback loops between Quality, Training, and Operations to maintain alignment and drive measurable improvement.
• Collaborate with data and analytics teams to define metrics, dashboards, and reporting that reflect quality outcomes and operational excellence.
• Develop and execute a comprehensive training strategy for new hires, ongoing education, and leadership development across domestic and global teams.
• Partner with HR to design internal professional development programs that set leaders up for success and create clear career pathways within RCMS.
• Oversee the creation, rollout, and maintenance of training materials.
• Ensure that client-specific and system access training requirements are met consistently and documented appropriately.
• Build and maintain a centralized repository for SOPs, job aids, and process documentation to ensure accessibility, version control, and standardization.
• Establish and enforce documentation standards across all RCMS functions, ensuring every process is defined, current, and aligned with best practices.
• Partner with the Implementation team to ensure all new client launches include the necessary training, access, and documentation components prior to go-live.
• Champion a culture of learning, quality, and innovation across RCMS.
• Facilitate collaboration between domestic and global teams to share best practices and promote standardization.
• Lead initiatives that simplify, streamline, and enhance operational delivery through better documentation, smarter training, and improved quality feedback loops.
• Drive adoption of technology solutions that support scalable training, documentation, and auditing processes.

Director – Operational Excellence

• Evaluate the accuracy, compliance, and effectiveness of revenue cycle processes across multiple departments.
• Conduct monthly audits of employee work across assigned revenue cycle departments, reviewing accounts.
• Document audit findings and provide constructive feedback.
• Collaborate with leadership during the rebuttal review cycle to adjust audit results.
• Identify patterns and recommend updates to Standard Operating Procedures (SOPs).

Revenue Cycle Auditor

• Provide strategic leadership for denial management, identifying, addressing, and escalating trends and root causes.
• Partner with domestic and global leaders to design, implement, and optimize operational processes and SOPs.
• Develop and deploy strategies to enhance outcomes, drive standardization, and improve efficiency.
• Collaborate with client operational leadership to identify best practices and translate them into effective workflows.
• Oversee rollout of SOPs, job aids, and training materials to ensure operational consistency and quality.
• Maintain regular communication with senior leadership, department heads, and partner leaders to share performance insights and align on goals.
• Oversee day-to-day denial management activities, ensuring team members meet quality and productivity expectations.
• Provide direct guidance, support, and coaching to AR Specialists; partner with quality team to review audits, identify gaps, and roll out training.
• Manage staffing schedules, approve time off, support onboarding, and ensure adequate coverage.
• Foster collaboration across domestic and global teams; promote continuous improvement and operational excellence.