RCM Workflow Specialist

Job description

ABOUT JOYFUL HEALTH Building the financial operating system for healthcare — and bringing the joy back to healthcare by fixing the financial chaos behind it. The healthcare payment system is a complex and inefficient maze. Healthcare practices leave $125 billion in revenue uncollected each year, lost in the chaos of fragmented financial data, manual workflows, and opaque payer systems. This financial uncertainty leaves practices struggling to stay afloat while valuable revenue slips through the cracks. Joyful Health is building an AI-powered financial operating system for healthcare practices. Our mission is to bring the joy back to running a private practice by simplifying financial operations so providers can focus on patient care. We spent 10 months working as fractional CFOs for a dozen practices, doing this work side by side with providers as we developed our product. We just announced our $22M Series A led by CRV and world-class investors including the founders of MongoDB & KAYAK. If you’re excited about combining real-world RCM expertise with product innovation, we’d love to meet you. THE ROLE The RCM Workflow Specialist sits at the intersection of revenue cycle operations and product intelligence. This is not a traditional billing role. You are responsible for two things that most billing professionals have never been asked to do together: 1) work real claims at an expert level and 2) translate that expertise into the structured data and direct feedback that powers Joyful’s AI product. Every action you take — every agent decision you review, every denial you analyze, every correction you document — directly improves how our system understands and solves revenue cycle problems. You are both: - An expert-level RCM practitioner - A collaborator who shapes how our AI learns This role is part of the RCM Center of Excellence (CoE) and partners directly with the Engineering and Product teams. There are two distinct tracks of work in this role: Track 1: Agent QA & Data Labeling: Structured, recurring. You review AI agent decisions on claims, label them correct or incorrect with rationale, and provide natural language corrections that feed directly into model training. The quality of your labels is what makes the model smarter. This requires genuine RCM expertise — many decisions are judgment calls, not rule lookups. Track 2: Product UX & Collaboration: Collaborative, fluid. You work directly alongside Engineering to pressure-test features against real-world RCM workflows. You tell us what’s hard to use, what doesn’t reflect how billing actually works, and what’s missing. You push back — this is an active, opinionated role, not a passive observer. WHAT YOU’LL DO EXECUTE HIGH-QUALITY CLAIMS WORKFLOWS - Work claims across denial, A/R, and follow-up workflows with a focus on accuracy and decision quality — not volume - Perform investigation, correction, and resolution of claims - Interact with payer systems, portals, and call centers as needed - Get creative when standard paths don’t work — you find a way to get the claim resolved. There is no such thing as “we can’t do it.” REVIEW AND LABEL AGENT DECISIONS - Review a statistical sample of AI agent–closed encounters each week and assess whether the agent’s action was correct, with a written rationale for your decision - Provide natural language corrections through the product interface (e.g., “We should have checked the payer portal before closing — there was a timely filing issue that needed a retro authorization”) - These corrections feed directly into model training — your expertise is what makes the system smarter - Flag patterns in where the agent consistently struggles or makes avoidable errors - Make confident calls on ambiguous scenarios — many of these are judgment calls, and sitting on the fence is not an option STRUCTURE DATA THROUGH LABELING - Translate claim activity into standardized, structured workflow outputs - Accurately label: - Denial categories and CARC/RARC codes - Root cause reasoning - Recovery actions taken - Outcomes (paid, denied, written off, appealed, etc.) - Ensure every claim worked and every agent review produces clean, structured data PARTNER DIRECTLY WITH PRODUCT & ENGINEERING - Work alongside engineers in a fast-moving, collaborative environment — engineers communicate directly and get to the point quickly; you need to be comfortable in that environment and able to hold your own on RCM expertise - Tell us when something is wrong — if a proposed workflow doesn’t reflect how billing actually works, say so clearly and explain why - Help validate whether features and agent behaviors reflect real-world RCM operations before they are released - Act as the voice of the RCM practitioner in product development — you are shaping how the system thinks, not just reviewing what it does - Leverage AI tools actively in your work — we expect everyone on this team to be pushing the boundary of what’s possible with the tooling available to them IDENTIFY PATTERNS & SURFACE INSIGHTS - Recognize trends across claims, payers, and denial types - Flag inconsistencies, contradictions, or unclear outcomes - Surface edge cases and breakdowns in workflows - Contribute to improving categorization logic, definitions, and SOP quality HOW YOU’LL BE MEASURED This role is measured on quality, not quantity. Throughput is not a primary metric — the goal is expert-level accuracy and meaningful insight generation. - Accuracy of data labels and agent QA decisions - Quality and confidence of rationale provided for ambiguous cases - Quality and specificity of product feedback — not just “this is broken” but “here’s why and here’s what should happen instead” - Consistency of workflow execution - Signal contribution to product and model improvements — measurable instances where your feedback changed something for the better - Independence and confidence on judgment calls — a key marker of success is that you don’t need to escalate ambiguous cases — you make a call and explain it WHAT SUCCESS LOOKS LIKE In 30 Days - Deep familiarity with Joyful workflows, the product interface, and labeling structure - Producing accurate, well-reasoned claim documentation and agent QA labels - Comfortable navigating payer systems and making independent decisions on clear-cut cases - Establishing a working relationship with the Engineering team — communication style calibrated, expectations clear In 90 Days - Independently working claims and QA-ing agent decisions across multiple denial categories - Consistently producing high-quality labeled data with clear, confident rationale - Actively identifying patterns and surfacing them as actionable insights — not just flagging problems - Comfortable making confident calls on ambiguous cases with minimal escalation - Feedback from Engineering that your product input is changing how they think about features In 6–12 Months - Recognized as a trusted RCM expert within the CoE — the person Engineering and the RCM Architect team go to when something is hard - Your corrections and labels have meaningfully improved agent performance — measurable reduction in agent errors in the categories you’ve been reviewing - Contributing to the evolution of workflow definitions, SOPs, and labeling logic - Operating at the frontier of what’s possible with AI-assisted billing — actively exploring where the system can do more WE’D LOVE TO HEAR FROM YOU IF… YOU HAVE - 5+ years of experience in medical billing, A/R, or denials with hands-on, claim-level expertise - Deep familiarity with payer portals, eligibility systems, and denial resolution workflows - Experience working claims across denial categories and navigating ambiguous payer decisions - Experience with specialties like ABA, behavioral health, or complex billing environments (preferred but not required) - A track record of using AI tools, automation, or technology to work smarter — this is a non-negotiable. If you haven’t adopted AI into your workflow, this role is not the right fit. YOU ARE - A relentless problem-solver on denials — there is no claim you won’t find a way to resolve. You’ve built payer relationships, figured out workarounds, and tried things other billers wouldn’t think to try. You can tell us about three creative things you’ve done to get a claim overturned that most people wouldn’t do. - Confident on judgment calls — when a case is ambiguous, you make a call and explain your reasoning. You don’t default to “maybe” when you mean “no.” - Willing to push back — you don’t accept “that’s how we’ve always done it” at face value. If something is wrong, you say so clearly and propose a better approach. - Comfortable with engineers — engineering communication is direct, fast, and sometimes feels confrontational — but it’s really just about getting to the truth quickly. You can hold your own in that environment and communicate your RCM expertise with confidence. - Detail-obsessed — you care about getting things exactly right, and your documentation reflects it - Systems-oriented — you notice patterns across claims, not just individual cases. You’re thinking about what’s causing a category of problem, not just fixing one instance. - Curious about why — you want to understand why something happened, not just resolve it and move on - A clear communicator across audiences — you can write a correction that an engineer can implement, a recommendation that an RCSM can act on, and an SOP that a biller can follow. These are different things, and you know the difference. - Open to iteration — you approach your own processes with the same curiosity you bring to claims. If there’s a better way to do something, you want to find it. WHY THIS ROLE MATTERS Most billing roles stop at resolution. This role goes further. You are helping build the intelligence layer that powers the future of RCM automation. When you label a decision, correct an agent, or flag a pattern, you are directly shaping how Joyful’s system gets smarter. This type of role doesn’t exist anywhere else in RCM. You won’t find another billing job that asks you to bring this depth of expertise to bear on how an AI learns. If you’ve spent years building real RCM knowledge and want to apply it somewhere that it will compound into something bigger than any single claim — this is it. Every claim you touch, every correction you make, every pattern you surface improves how Joyful: - Understands denials across payers and specialties - Prioritizes and automates the right work - Drives better financial outcomes for practices - Builds a product that actually reflects how RCM works OUR VALUE PROP TO YOU 🚀 Meaningful Impact Your work directly contributes to fixing one of healthcare’s most broken systems — and unlike most billing roles, you’ll see the impact of your expertise reflected in a product that gets smarter because of you. 🔑 Ownership You’re not just executing tasks — you’re shaping how the system learns, what it gets right, and where it needs to improve. This is a role with real influence. 📈 Growth Gain deep exposure to: - Advanced RCM strategy and the RCM Center of Excellence - AI product development in a way that almost no billing professional ever gets - Data-driven operations at the frontier of healthcare technology 💰 Compensation & Equity Competitive salary + equity in a high-growth company backed by world-class investors. ❤️ Be Your Best Self Comprehensive healthcare benefits, unlimited PTO (with a minimum of 10 days off a year), flexibility, and a team that cares about doing this right. We organize regular team off-sites and invest in your professional development.