Healthrise

Recruitment

• Own end-to-end recruiting for an active portfolio of 15-25 open requisitions across revenue cycle consulting, clinical, coding, and operational roles at any given time.
• Partner with hiring managers from intake through offer acceptance; including job scoping, sourcing strategy, candidate review, interview coordination, debrief facilitation, and offer negotiation.
• Write and post compelling, accurate, and inclusive job descriptions and postings that reflect the firm’s brand and attract qualified candidates.
• Manage candidates with consistent, timely updates and disposition documentation that supports compliance and reporting.
• Deliver an exceptional candidate experience from first contact through day one; ensuring every candidate, placed or not, leaves the process with a positive impression of the firm.
• Develop and execute multi-channel sourcing strategies using LinkedIn Recruiter, Indeed, professional associations (HFMA, AAPC, AHIMA, MGMA), referral networks, and niche healthcare job boards.
• Build and maintain proactive talent pipelines for recurring and hard-to-fill roles including HIM/Coding specialists, RN clinical reviewers, denial management professionals, CDI specialists, and revenue cycle project managers.
• Leverage Boolean search, talent mapping, and competitive intelligence to identify passive candidates in the revenue cycle consulting market.
• Maintain a network of revenue cycle professionals through consistent outreach, relationship nurturing, and community engagement; converting passive talent into active pipeline.
• Collaborate with marketing and leadership on employer branding initiatives, including conference presence, LinkedIn content, employee spotlights, and Glassdoor reputation management.

Senior Healthcare Recruiter

Medical Billing and Coding

• Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and judgment within the Hospital and/or Medical Group partner revenue operations.
• Serves as part of a team of coding denials resolution specialists responsible for identifying and determining root causes of denials.
• Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers.
• Promotes departmental awareness of coding best practices.

Coding Denials Resolution Specialist

Accounts Receivable

• 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).
• Serves as part of the Denials Resolution team responsible for ensuring payments are received on denied accounts, determining root causes for discrepancies, minimizing inappropriate payment delays and variances from expected reimbursement, and resolving or escalating issues.
• 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 resulting from rejected and/or denied claims, overpayments, or underpayments.
• Processes payments as appropriate in accordance with contracts and policies to ensure timely and accurate liability resolution.
• Resolves claims, conducts formal account reviews, identifies lost charge recovery, and analyzes/documents delays and payment variances.
• Identifies routine issues and resolves or escalates 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 with the goal of optimizing reimbursement.
• 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 to ensure prompt reimbursement, refiles accurate claims, and documents findings.
• Contacts insurance carriers and patients as necessary to resolve outstanding balances.
• Monitors timely filing limits specific to California payers and ensures all claims are submitted within state and payer deadlines.
• 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 commercial, government, and managed care payers.
• Identifies root causes of denials (coding errors, eligibility issues, missing documentation, etc.) 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.
• Cross-trains in various functions to enhance service delivery.
• Interprets data, draws conclusions, and reviews findings with supervisor.
• Continuously learns all aspects of the Denials Resolution Specialist role.
• Performs other duties as assigned. Maintains a working knowledge of applicable Federal, State, and local laws/regulations.

AR Specialist

Billing Specialist

• Performs day-to-day billing activities for Hospital (HB) and/or Medical Group (PB) claims, including claim generation and transmission
• Responsible for primary, secondary, and tertiary billing, resolving claim edits and rejections, and ensuring claims are transmitted in compliance with payer guidelines
• Serves as part of the Billing team to ensure timely, accurate, and compliant billing operations
• Identifies routine billing issues and resolves or escalates them as appropriate
• Maintains working knowledge of state and federal laws related to insurance contracts and payer billing timelines
• Investigates and addresses overpayment and underpayment accounts to optimize reimbursement
• Applies payer rules, contracts, schedules, and related data to ensure claims are billed accurately and timely
• Researches payer trends and provides feedback to improve billing accuracy and operational efficiency
• Tracks and reports denial types and root causes, recommending process improvements
• Analyzes, categorizes, and resolves claim rejections from commercial, government, and managed care payers
• Documents all actions and follow-up activities in the patient accounting system
• Responds to patient and payer inquiries or refers them appropriately
• Prepares and submits reports documenting billing trends, outcomes, and claim activity
• Interprets data, draws conclusions, and reviews findings with supervisor
• Cross-trains in various functions to enhance service delivery
• Maintains knowledge of applicable federal, state, and local laws and regulations
• Performs other duties as assigned

Billing Representative

Manager

• Lead the day-to-day performance of a coding team with a primary focus on identifying, resolving, and preventing coding-related denials across DRG, CPT, HCPCS, and ICD-10 coding.
• Monitor broader productivity and quality metrics, coaches and develops coding staff.
• Serve as the first point of escalation for complex coding questions and documentation issues.
• Partner with revenue cycle and appeals teams to reduce denial volume and recover revenue.
• Conduct performance reviews and regular coaching.
• Perform regular quality audits of team coding accuracy across DRG, CPT, HCPCS, and ICD-10 assignment.
• Identify trends contributing to denials or revenue variance within the team's work and escalate findings to the Director of Coding.

Manager, Coding Denials

Director

• Governance Committee Leadership (Operations–IT Integration)
• Knows, understands, incorporates, and demonstrates the Healthrise Core Values in all interactions with team members, clients, and stakeholders.
• Design, launch, and chair a cross-functional IT/RCM governance committee responsible for reviewing, triaging, and prioritizing IT optimization tickets and Epic build requests that affect revenue cycle.
• Establish and maintain a formal request intake process aligned with ITIL/ITSM best practices, including categorization, SLA tracking, risk tiering, and stakeholder communication cadences.
• Develop governance charters, meeting rhythms, and escalation protocols to ensure issues are resolved at the appropriate organizational level, with regular reporting to Director, VP, and C-suite audiences.
• Maintain a living prioritization roadmap that balances operational urgency, financial impact, technical complexity, and resource availability across concurrent IT and RCM initiatives.
• Prepare and deliver monthly Steering Committee materials for executive leadership, including governance metrics, initiative status, risk summaries, and prioritization rationale.
• Establish and maintain governance performance dashboards tracking key revenue cycle KPIs (including DNFB, clean claim rate, denial rate, days in AR, and cash collection) ensuring real-time visibility for operational and executive stakeholders and driving data-informed prioritization of IT enhancement requests.
• Epic and EHR Workflow Expertise (IT-Side Integration Knowledge)
• Serve as the organization’s primary authority on end-to-end Epic workflow impacts across revenue cycle domains, including patient access, charge capture, HIM/coding, claims, denial management, and patient financial services — with particular depth in Hospital Billing (Resolute HB), Ambulatory/Professional Billing (Resolute PB), and PFS-facing Epic modules such as payment posting, credit balance, self-pay collections, and statements.
• Evaluate Epic IT tickets and enhancement requests for downstream revenue cycle implications, ensuring that build decisions do not inadvertently create compliance risk, billing delays, or reimbursement leakage.
• Partner with Epic application analysts and IT build teams to review proposed configurations prior to deployment, confirming alignment with RCM workflow requirements.
• Evaluate, govern, and champion the adoption of Epic AI modules, RCM-specific artificial intelligence solutions, and best-in-class automation technologies, including RPA and predictive analytics tools, to streamline key revenue cycle functions such as prior authorization, denial prevention, coding assistance, and claim scrubbing.
• Support clinic integration and acquisition activity by defining Epic build standards and workflow expectations for newly onboarded facilities, bringing systems back to a consistent foundation.
• Stay current on Epic release cycles, upgrade content, and new module capabilities with potential benefit to revenue cycle performance and communicate relevant updates to stakeholders.
• Revenue Cycle Alignment and Optimization (Operations-Side Integration Knowledge)
• Apply HFMA-aligned best practices to assess current-state revenue cycle performance and identify where IT system gaps, misconfigurations, or optimization opportunities are contributing to revenue leakage or operational inefficiency.
• Champion a process-first philosophy consistent with HFMA’s framework: ensure workflow standardization and data governance precede technology layering so that automation and system enhancements accelerate value rather than amplify variability.
• Collaborate with CDI, coding, patient access, and billing leadership to identify documentation and workflow gaps that have downstream system and reimbursement consequences.
• Lead or advise on Patient Financial Services strategy, including self-pay and insured follow-up workflows, bad debt segmentation, early-out and collections vendor governance, and payment plan configuration in Epic — ensuring both Hospital and Ambulatory billing functions operate from a consistent, optimized system foundation. Treat data integrity as a financial control (not merely an IT project) ensuring underlying data quality supports accurate analytics, automation, and compliant reimbursement.
• Project Management and Cross-Functional Execution (Integrator in Action)
• Manage a portfolio of concurrent IT/RCM optimization initiatives from request intake through go-live, applying structured project management methodologies (PMI/PMP or equivalent frameworks).
• Develop and maintain project documentation including charters, status dashboards, risk registers, and issue logs, ensuring visibility to all stakeholder levels.
• Apply change management best practices to support user adoption of system enhancements and new workflows across both IT and RCM teams.
• Identify, escalate, and mitigate implementation risks proactively, particularly during periods of acquisition-driven integration activity and clinic onboarding.
• Maintain project documentation including status updates, issue tracking, and mitigation strategies.
• Travel to client or organizational sites as required to support on-the-ground governance facilitation and stakeholder alignment.

Director, Epic Go-Live Integration

• Perform detailed assessments of charging and coding practices across facility and/or professional services (i.e., complex service lines such as cardiology and neurosurgery) to identify compliance risks, revenue leakage, and process inefficiencies.
• Evaluate Charge Description Master (CDM) structure, charge capture workflows, and coding alignment with CPT, HCPCS, ICD-10, and payer-specific requirements.
• Analyze documentation, coding patterns, and charge utilization to identify optimization opportunities and root causes of revenue variance.
• Develop structured findings, gap analyses, and prioritized recommendations aligned to regulatory guidance and industry best practices.
• Lead project workstreams focused on implementation of charging and coding improvements, including workflow redesign, charge capture controls, and CDM updates.
• Partner with client operational leaders, revenue integrity teams, compliance, and clinical departments to support adoption of recommended changes.
• Translate complex regulatory requirements into practical operational guidance.
• Support development of executive-level summaries outlining financial impact, compliance exposure, and implementation roadmap.
• Collaborate with cross-functional teams to ensure alignment between clinical documentation, coding, and charge capture processes.
• Utilize Epic and/or other EHR reporting tools to validate charge logic, identify trends, and support data driven recommendations.
• Maintain project documentation including status updates, issue tracking, and mitigation strategies.
• Travel to client or organizational sites as required to support on-the-ground project execution.

Coding Director

Operations

• Act as a trusted partner to the Chief of Staff.
• Anticipate what the Chief of Staff and COO need before they ask.
• Manage the Chief of Staff's agenda, commitments, and follow-through cadence.
• Work across health systems, medical groups, finance, and operational teams.
• Drive operational consistency and performance improvement across markets.
• Independently manage multiple concurrent strategic and operational initiatives.
• Build and maintain performance dashboards and tracking frameworks.

Executive Director – Strategy and Operational Excellence

• Responsible for day-to-day supervisory oversight and operational execution of technical and coding denial management functions within the Revenue Cycle department.
• Lead a team of denial specialists and coordinators focused on resolving technical and coding-related claim denials across all payer types, facilities, and service lines.
• Manage daily denial work queues for technical and coding denial categories, ensuring cases are assigned, prioritized by financial impact and deadline risk, and resolved within payer-required timelines.
• Monitor team workload, capacity, and throughput on a daily and weekly basis; adjust case assignments and staffing allocation to prevent missed filing deadlines.
• Serve as the first-line escalation point for complex technical and coding denial cases that require manager-level review, payer contact, or cross-functional coordination.
• Track and report weekly team performance to the Director including denial volumes, appeal activity, resolution rates, write-off risk, and aging by payer, denial code, and category.
• Identify systemic denial patterns or payer behavior trends in the queue and escalate to the Director with root cause analysis and recommended corrective actions.
• Oversee resolution of technical denials including timely filing, prior authorization, eligibility, coordination of benefits, duplicate billing, medical records requests, and credentialing-related claim rejections.
• Review and approve appeal submissions for high-dollar or complex technical denials prior to filing, ensuring accuracy, completeness, and appropriate supporting documentation.
• Partner with Patient Access, Provider Enrollment, Utilization Management, and Billing to trace technical denial root causes back to the point of origin and drive sustainable upstream corrections.
• Conduct structured root cause analyses on high-volume technical and coding denial categories; present findings and corrective action plans to the Director with supporting denial data.

Manager, Denials Operations

• Provides enterprise-level strategic and operational leadership over the organization’s denial management and post-payment audit defense programs.
• Drives towards measurable improvement in overturn rates, write-off reduction, and audit recoupment defense across all facilities and service lines.
• Owns the end-to-end denial lifecycle: prevention strategy, appeal operations, payer relations, post-pay audit response, and the technology and analytics infrastructure supporting the program.
• Partners directly with the VP of Revenue Cycle, CFO, CMO, and CNO to translate denial data into enterprise-wide corrective action and sustainable revenue protection.
• Establish annual goals for denial overturn rate, appeal yield, write-off reduction, and audit recoupment defense; report performance to executive leadership monthly.
• Directs the clinical appeals team handling medical necessity, level-of-care, length-of-stay, and DRG clinical validation denials.
• Oversees preparation of evidence-based appeal letters citing InterQual, MCG, CMS NCD/LCD, and payer medical policy.
• Manages the physician advisor program and peer-to-peer review workflow for concurrent and retrospective denials.
• Leads the coding denial team responsible for DRG downgrades, HCC validation, MS-DRG/APR-DRG disputes, modifier denials, and code-edit rejections.
• Ensures compliant rebuttal of coding-related findings from commercial payers, Medicare Advantage, RAC, MAC, and SIU audits.
• Directs the response to all post-payment audits and manages ADR workflows, audit logs, and other responses within CMS deadlines.
• Builds career ladders, productivity standards, and quality assurance programs for each function.

Senior Director, Denials Management

• Provide strategic and operational leadership across reimbursement integrity, payment validation, revenue optimization, and payer oversight activities across the health system.
• Drive initiatives focused on financial accuracy, reimbursement integrity, operational improvement, and regulatory compliance across the revenue cycle continuum.
• Partner with Revenue Cycle, Compliance, Finance, HIM, Managed Care, and Clinical Operations leadership to identify reimbursement trends and improve operational workflows.
• Oversee complex payer review activity, reimbursement escalations, external validation requests, and governmental and commercial payer inquiries.
• Develop and manage reimbursement resolution strategies including appeals coordination and payer dispute management.
• Recruit, lead, and develop a team of revenue integrity analysts and reimbursement specialists; set performance goals and ensure staff education and training.
• Ensure all reimbursement integrity and payment review activities comply with CMS regulations, OIG guidance, False Claims Act requirements, and applicable state laws.
• Drive identification and resolution of reimbursement variances and payment discrepancies impacting organizational financial performance.
• Collaborate with Clinical Documentation Improvement (CDI), Case Management, Coding, and Billing teams to address audit findings.

Director, Revenue Integrity Strategy

• Provides specialized operational and strategic leadership over the full scope of the organization's clinical denial management function.
• Responsible for driving clinical appeal performance across medical necessity, level-of-care, length-of-stay, DRG clinical validation, and experimental or non-covered service denials for all payer types and service lines.
• Owns the clinical denial function end to end, from the quality of individual appeal letters to the design of appeal workflows.
• Develops clinical appeal writers and manages cross-functional partnerships that address root causes before denials occur.
• Engages physician advisors, payer medical directors, and executive stakeholders with confidence.
• Builds a high-performing clinical appeals team and shapes the clinical denial strategy for a complex, multi-payer organization.

Director, Clinical Denials

Financial Planning and Analysis

• Serve as the operational leader over PFS functions for assigned Healthrise clients, ensuring day-to-day activities meet or exceed performance standards.
• Directly manage and mentor team leads, supervisors, and staff across multiple functional areas (hospital billing, professional billing, A/R follow-up, denials, customer service, etc.).
• Use data-driven insights to identify pain points and take a proactive, action-oriented approach to resolving them, whether that means coaching a team, implementing a new workflow, or stepping in personally to solve a persistent issue.
• Partner with analytics and client stakeholders to define KPIs and develop performance dashboards.
• Implement best practices across systems and teams, especially in Epic, Cerner, or Meditech environments.
• Lead with a “boots-on-the-ground” mindset, participate in root cause reviews, help draft appeal letters, coach teams on difficult accounts, and develop SOPs from real-time observations.
• Drive employee engagement and foster a strong, accountable team culture through transparent communication, clear expectations, and continuous feedback.