Assess current denials processes and analyze denial trends to identify root causes and financial risks.
Develop and implement strategies to reduce preventable denials and improve revenue cycle performance.
Lead denials-related projects from planning through implementation, coordinating with stakeholders and tracking KPIs.
The Wilshire Group is a boutique healthcare consulting firm specializing in revenue cycle, Epic, and healthcare technology solutions. We are a small team of experienced professionals dedicated to improving financial performance for healthcare organizations.
Own and scale the RCM engine across payer contracting, billing, denials, collections, and reconciliation.
Lead the RevOps team and act as the go-to expert on revenue cycle performance.
Drive root-cause resolution of denials and build process improvements for audit-ready scale.
Clarity Pediatrics is redefining pediatric chronic care by uniting virtual multi-specialty care for kids with ADHD, allergies, asthma, and obesity. It has raised $25M from top VCs and is scaling after a substantial Series A.
Drive strategic pricing, financial modeling, and hybrid billing structures to maximize revenue and growth.
Collaborate with the tech team to optimize the RCM tech stack and ensure seamless data integrity.
Lead operational quality, denial management, and cross-functional project management for billing workflows.
Pomelo Care is the leading virtual medical practice for women and children, providing proactive, 24/7 clinical care across pregnancy, postpartum, pediatrics, menopause, and perimenopause. The team includes clinicians, technologists, operators, and problem-solvers working together to make high-quality care more accessible for families nationwide.
Respond to client and team information requests in a timely, professional manner.
Communicate with insurance carriers to resolve claim issues and improve cash flow.
Contribute to training materials and maintain proactive communication with clients.
Ternium RCM specializes in resolving complex healthcare insurance claim denials and delays, empowering hospitals to focus on patient care. They are a growing team of dedicated professionals committed to optimizing revenue cycles and improving healthcare outcomes.
Lead strategic operational and technology initiatives from planning through go-live, ensuring alignment with objectives and timelines.
Drive technology implementations across Patient Access and Pre-Access, including insurance verification and revenue cycle solutions.
Monitor key performance indicators to reduce denials, improve point-of-service collections, and optimize cost-to-collect.
The organization is a healthcare revenue cycle management company focused on improving patient access and pre-access operations. It offers a collaborative culture with remote work opportunities and professional development.
Respond to patient billing and insurance inquiries via Zendesk, resolve financial questions, and manage payment arrangements with empathy.
Work Athena claim hold and denial queues, research claims in payer portals, and coordinate with clinical teams to resolve documentation gaps.
Serve as billing and insurance subject matter expert for the Patient Experience team, identify root causes of denials, and support process improvements.
Midi Health is a comprehensive virtual care clinic for women in midlife, focusing on perimenopause, menopause, and midlife health challenges. It is a fast-growing telehealth company with a collaborative, remote-first culture.
Manage DRG-related payer denials to protect reimbursement and minimize revenue loss.
Leverage clinical and coding expertise to produce compliant appeal outcomes.
Identify documentation and coding risks pre-claim to strengthen revenue integrity.
Rochester Regional Health is an integrated health services organization serving Western New York and beyond, with nine hospitals and numerous care facilities. It is a large health system focused on leading the evolution of healthcare.
Lead and scale a high-performing Revenue Cycle Management team, managing workflows and driving operational excellence.
Oversee day-to-day RCM operations with a patient-first approach, optimizing collections and efficiency.
Collaborate cross-functionally with Engineering, Credentialing, Customer Experience, and external vendors to support growth.
Nourish is an AI-native digital health system that connects patients with registered dietitians, physicians, medications, lab testing, and AI agents for insurance-covered care. Founded four years ago, it has completed millions of appointments, tripled year-over-year, and partners with health plans covering 200M+ Americans.
Analyze revenue cycle processes and performance data to identify trends and improvement opportunities.
Collaborate with revenue cycle teams to implement process enhancements and monitor KPIs.
Support root cause analysis of denials and inefficiencies to improve financial outcomes.
Beyond Blue Corporation is a nonprofit affiliated with the University of Kentucky, supporting the university's growth through strategic business separation. It fosters a diverse, inclusive, and purpose-driven culture focused on advancing Kentucky's economy and health.
Own RCM end to end for Medicaid and Medicare, from eligibility through claims, denials, and collections.
Lead strategy, team building, KPI reporting, and cross-functional collaboration with operations, product, and engineering.
Analyze claims data to improve collection rate, manage payer relationships, and ensure billing compliance.
Pair Team is an AI-enabled medical group for Medicaid and Medicare, delivering whole-person care through community-based organizations. It is California's largest complex care provider and is building an AI platform to scale across the safety net.
Review and evaluate denied claims using proprietary software to determine correct reimbursement.
Research and acquire medical records and supporting documentation for submission to payers.
Conduct telephone follow-up with payers to ensure prompt reimbursement.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations using an intelligent automation platform. The company has over 24 years of industry expertise, is a multi-year Top Workplaces award recipient, and has been on the Inc. 5000 list for eleven years.
Maximize client satisfaction by analyzing data and implementing improvement plans.
Develop strategies for client retention, engagement, and expansion.
Build relationships with client partners to identify upselling opportunities.
Experian is a global data and technology company powering opportunities for people and businesses worldwide. They have 25,200 employees across 32 countries and foster a people-first, inclusive culture.
Oversee day-to-day operations of the Unresponded team, including offshore and onshore staff, to drive resolution of post-appeal payer responses.
Partner cross-functionally with Denials & Appeals, Technology, and operational leadership to reduce backlog and maintain SLA compliance.
Build and refine standard operating procedures and workflows to sustain SLA compliance as volume scales.
Natera is a global leader in cell-free DNA testing, dedicated to oncology, women’s health, and organ health. The company consists of highly dedicated professionals from world-class institutions who care deeply for their work.
Manage billing, collections, and accounts receivable for healthcare clients, ensuring timely claim submission and payment resolution.
Analyze aging reports, denials, and reimbursement trends to identify root causes and implement process improvements.
Serve as primary client contact, providing ongoing communication, status updates, and revenue cycle support.
Wipfli is a professional services firm providing accounting, tax, and consulting services. They emphasize flexibility, relationships, and employee well-being, with a focus on creating exceptional impact.
Serve as the operational lead and subject matter expert for enterprise client accounts, overseeing accounts receivable and revenue cycle performance.
Drive root cause analysis of denied claims, payment variances, and workflow breakdowns to implement corrective actions.
Mentor team members, assign workloads, and facilitate training to ensure high-quality client support and operational consistency.
Prompt provides software for outpatient rehab organizations, helping them treat more patients and deliver better care while reducing environmental waste. It is a team of talented individuals committed to solving complex healthcare problems, fostering a culture of smart work and positive impact.