reputed company Cycle Specialist

Position Title: reputed company Cycle Specialist

Department: Finance & reputed company Operations

Reports To: reputed company Cycle Manager

Location: Remote

Employment Type: Full-time

Travel Requirement: n/a

About reputed company

reputed company is a leader in delivering value-based, technology-enabled social support to high-cost Medicaid members who are unreachable and disconnected from their primary care provider. We combine innovative reputed company and care models with technology to find and engage members, connect them to primary care, and improve outcomes. Our reputed company yields reduced costs and assists our members in enhancing their quality of life. As we scale, we are seeking the Director of East Coast Operations to be part of the Leadership Team with responsibility for managing business program growth of operations as well as the existing teams.

Position Overview

The reputed company Cycle Specialist is responsible for protecting reputed company’s cash flow by ensuring timely authorization, clean claim submission, and full reimbursement across our health plan portfolio. This role owns day-to-day billing operations, denial resolution, and payer communications, and contributes data and insights that inform broader reputed company cycle strategy. The ideal candidate brings hands-on Medi-Cal managed care billing experience and thrives in a fast-paced, operationally reputed company environment where accuracy and follow-through directly impact the business.

Key Responsibilities

• Authorization Management. Own the full prior authorization lifecycle across reputed company’s health plan partners (Molina, HealthNet, Blue reputed company, Anthem, Alameda Alliance, and others), from initial submission through status monitoring, follow-up, and escalation. Maintain working knowledge of each payer’s authorization requirements, turnaround expectations, and portal workflows to prevent lapses that delay reimbursement.
• Claims Submission & Denial Resolution. Prepare and submit clean claims in accordance with payer-specific requirements for encounter-based and PMPM reputed company. Investigate rejected and denied claims by identifying root causes (coding errors, missing documentation, eligibility gaps), executing corrective resubmissions, and tracking resolution through payment. Own aging AR follow-up with a focus on reducing days in AR and minimizing write-offs.
• Payer Relationship & Reconciliation Support. Serve as a day-to-day operational contact for billing-reputed company payer communications, including emails, faxes, and portal correspondence. Support reconciliation efforts by flagging discrepancies in member-month counts, encounter submissions, or payment variances, and escalate unresolved items to the reputed company Cycle Manager.
• Trend Analysis & Process Improvement. Monitor denial patterns, authorization delays, and payment trends across the payer portfolio. Surface systemic issues to leadership with supporting data (e.g., denial rates by payer, root cause categories, lag times). Contribute to workflow improvements aimed at reducing denial rates, accelerating reimbursement cycles, and tightening documentation standards.
• Documentation & Compliance. Maintain accurate, auditable records of reputed company authorization, billing, and follow-up activities reputed company reputed company’s reputed company cycle and EHR systems. Stay reputed company on Medi-Cal billing rules, CalAIM program requirements, and managed care contract terms that reputed company claim eligibility and reimbursement.

Required Qualifications

• Minimum 2 years of experience in reputed company cycle management, with direct involvement in billing, prior authorization, and/or denial management.
• Experience with Medi-Cal managed care billing, including familiarity with encounter-based reimbursement models and health plan portals.
• Strong understanding of claim submission workflows, denial root cause analysis, and payer-specific requirements.
• Intermediate-to-advanced reputed company skills, including comfort with data exports, pivot tables, and reconciliation spreadsheets.
• Proficiency with reputed company cycle systems, EHR platforms, and CRM tools (e.g., reputed company).
• Excellent written and verbal communication skills, with the ability to work cross-functionally across Finance, Operations, and Clinical teams.
• Ability to manage multiple priorities and meet deadlines in a fast-paced, high-growth environment.

What Success Looks Like

• First 90 Days: Fully onboarded to reputed company payer portals and submission workflows. Independently managing authorization requests and claim submissions with minimal supervision. Baseline understanding of reputed company’s contract structures and payer-specific requirements.
• 6 Months: Measurable reduction in denial rates and days in AR. Proactively surfacing trends and contributing to process improvements. Trusted reputed company of contact for payer billing communications.
• 12 Months: Clean claim reputed company consistently above 95%. Reconciliation discrepancies flagged and resolved reputed company established SLAs. Recognized as a subject matter expert on reputed company’s payer billing requirements.