Revenue Cycle Specialist 

About Avail Health 

Avail Health is a Nurse Practitioner–founded organization dedicated to removing barriers to care, access, and meaningful clinical work for Medicare-age individuals. We combine thoughtful technology, strong operational infrastructure, and deep respect for the patient–provider relationship to enable nurse-led virtual and mobile care. By empowering nurses, reducing administrative burden, and supporting consistent, high-integrity clinical practices, we deliver compassionate, high-quality care through scalable, team-based, and data-driven care models that improve access, quality, and patient outcomes in the communities we serve. 

Role Summary 

The Revenue Cycle Management Specialist is responsible for managing and executing day-to-day revenue cycle activities to ensure accurate billing, timely reimbursement, and regulatory compliance across Avail Health programs. This role supports patient registration, insurance verification, medical coding, claims submission, payment posting, and denial management with commercial FFS payors, Medicare Advantage, traditional Medicare, and includes RCM work specific to GUIDE, CCM, and TCM. This role will also directly support and execute provider-credentialing and enrollment activities considering so much of successful RCM is reliant upon accurate and complete maintenance of provider data. 

The RCM Specialist serves as a key operational partner to Clinical Operations, Care Delivery, Finance, and Analytics teams, ensuring that revenue processes align with clinical workflows and organizational goals. This position reports directly to the Vice President of Operations and collaborates closely with internal and external stakeholders. 

This is a primarily remote, work-from-home role requiring a reliable high-speed internet connection and a dedicated, HIPAA-compliant workspace to support confidential patient and financial information. Minimal travel may be required for team meetings or operational initiatives. Standard business hours are Monday–Friday, 8 a.m. to 5 p.m. Eastern Time, with flexibility required to accommodate payer timelines and month-end close activities. 

Position Overview 

This is a hands-on revenue cycle role responsible for ensuring end-to-end accuracy and efficiency of Avail Health’s billing and reimbursement processes. The Revenue Cycle Management Specialist supports the full lifecycle of patient accounts—from registration through final payment—while identifying and resolving issues that impact cash flow, compliance, and patient satisfaction. 

The RCM Specialist is accountable for maintaining clean claims, reducing denials, improving turnaround time for payments, and collaborating with internal teams to continuously refine billing workflows. This role requires strong attention to detail, payer knowledge (particularly Medicare Advantage), and the ability to work independently in a fast-paced, evolving environment. 

Key Responsibilities 

1. Patient Registration, Insurance Verification & Eligibility 

Translate clinical services into accurate, compliant medical codes (e.g., ICD-10, CPT, HCPCS) in alignment with documentation standards and payer guidelines. Review documentation for completeness and partner with clinical and operations teams to resolve discrepancies that may impact billing accuracy. 

2. Medical Coding & Charge Capture 

Serve as the primary operational resource for frontline clinical teams, providing real-time support to address day-to-day needs, remove barriers, and maintain continuity of care. Coordinate scheduling and field support for mobile teams, and ensure workflows, tools, and processes enable clinicians to operate effectively. Partner closely with clinical leadership to reinforce expectations, improve throughput, and support high-quality, compliant care delivery. 

3. Claims Submission & Billing Execution 

Prepare, review, and submit clean, correctly coded claims to Medicare Advantage plans and other payers in a timely manner. Monitor claims through adjudication, identify errors proactively, and ensure claims are processed efficiently to minimize delays in reimbursement. 

4. Payment Posting, Reconciliation & Cash Flow Optimization 

Post insurance and patient payments accurately, reconcile remittances, and investigate underpayments or variances. Track accounts receivable and follow up on outstanding balances to support consistent cash flow and financial performance. 

5. Denial Management, Appeals & Continuous Improvement 

Analyze denied or rejected claims, identify root causes, and correct and resubmit claims promptly. Manage appeals as needed, track denial trends, and collaborate cross-functionally to implement process improvements that reduce future denials and improve first-pass claim acceptance rates. 

6. Cross-Functional Collaboration & Compliance 

Partner with Clinical Operations, Care Delivery, Finance, Quality/Compliance, and Analytics teams to ensure billing workflows align with clinical practices and regulatory requirements. Support audits, documentation reviews, and payer inquiries as needed to maintain compliance and reduce financial risk. 

Required Qualifications 

• Associate’s or Bachelor’s degree in healthcare administration, business, finance, or a related field; or equivalent combination of education and experience 

• 3+ years of experience in revenue cycle management, medical billing, or healthcare reimbursement 

• Demonstrated experience with patient registration, insurance verification, medical coding, claims submission, and payment posting 

• Strong understanding of Medicare Advantage and managed care billing workflows 

• Experience managing claim denials, corrections, and appeals  

• High attention to detail with strong analytical and problem-solving skills  

• Proficiency with EHR systems, billing platforms, and clearinghouse tools  

• Knowledge of healthcare regulatory and compliance requirements  

• Authorization to work in the United States  

• Ability to work an Eastern Time Zone schedule 

Preferred Qualifications 

• Certification in medical coding or billing (e.g., CPC, CCS, CPB)  

• Experience supporting nurse-led, virtual, or mobile care models  

• Familiarity with risk adjustment–related services and documentation  

• Experience tracking and reporting revenue cycle performance metrics  

• Experience in a startup or high-growth healthcare environment 

What Success Looks Like 

• Accurate and timely patient registration, insurance verification, and charge capture  

• Clean claims submitted consistently with high first-pass acceptance rates  

• Reduced claim denials through proactive management and process improvement  

• Timely payment collection from payers and patients, supporting strong cash flow  

• Clear, compliant, and patient-friendly billing practices that enhance patient satisfaction 

• Strong collaboration with clinical and operational teams to align billing with care delivery 

• Consistent adherence to regulatory requirements, reducing audit and compliance risk  

• Ability to work independently while maintaining accountability and performance standards 

• Contribution to scalable, standardized revenue cycle workflows that support organizational growth 

Compensation & Benefits 

• Benefits Package: Medical, dental, and vision insurance, in accordance with company benefit plans and eligibility requirements.  

• Paid time off: 3 weeks annually (accrued per pay period) 

• Holidays: 8 paid holidays plus 1 floating holiday 

• Retirement: 401(k) plan with 2% employer match 

• Base salary: $55,000 – $65,000, commensurate with experience 

• Performance bonus: Quarterly bonus of up to 2.5% of annual salary. Performance bonuses are tied to operational KPIs, including access, documentation quality, productivity, and program execution milestones. 

• Annual salary increase: Up to 5% of base salary, subject to performance review 

Additional Information 

• Our company is growing! We welcome candidates with leadership and management experience as the role may evolve quickly.