About This Role
This role involves overseeing the entire revenue cycle, from initial claim submission to payment reconciliation and rejection resolution. It suits a specialist with a strong background in medical billing, capable of managing multiple functions and prioritizing tasks effectively.
Responsibilities
- 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
- Communicate directly with payer representatives to resolve outstanding balance disputes
- Coordinate with the RCM platform team on shared AR workqueues
- Perform pre-submission claim scrubbing
- 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
- Resolve claim rejections from RCM platform and payer portals
- 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
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
- 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
Nice to have:
- 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
About the Company
Sprinter Health aims to improve access to healthcare by bringing care directly to patients' homes. The company has supported over 2 million patients across 22 states, completed more than 130,000 in-home visits, and maintained a 92 NPS. Sprinter Health's team has raised over $125M in funding from investors like a16z, General Catalyst, GV, and Accel.
