Revenue Cycle Management Consultant

Vayu Health is a non-profit startup run with for-profit operational efficiency. We provide personalized, whole-person, value-based care for rising and high-risk Medi-Cal members managing complex chronic conditions, with an initial focus on individuals with uncontrolled diabetes. Our hybrid local and virtual care enablement model features community-embedded Community Health Workers (CHWs) supported by virtual clinical specialists. Rather than replacing local Primary Care Providers (PCPs), our wrap-around teams partner with them to remove social, behavioral, and structural barriers to health. Consulting Project Details Engagement Type: Contract / Consulting Approx. 40 hours/month Duration: Ongoing Reporting: Reports directly to Vayu’s Sr. Director of Clinical Operations, with a dotted line to Vayu’s Finance consultant for financial oversight Position Overview We are seeking an analytical, detail-oriented Revenue Cycle Management (RCM) Consultant for a targeted contract engagement. This role will audit, clean up, and optimize our medical billing operations between our clinical teams and our technology platform partner (Sprite Health). Scope of Work Claims Audit & Reconciliation: Review and cross-reference monthly clinical encounter logs against submitted claims to catch and rectify missing, duplicate, or incorrectly formatted ECM, ECM+, and Outreach claims. Denial & Dispute Resolution: Investigate a backlog of $0-paid and denied claims from Q4 2025 and Q1 2026. Formulate, track, and electronically submit Provider Dispute Resolutions (PDRs) through the provider portals. Remittance Advice (RA) Alignment: Manage the manual posting of electronic and paper ERAs/EOBs into the RCM platform where automatic electronic syncing fails, ensuring the system dashboard accurately reflects actual revenue received. Manual Claims Tracking & Payment Reconciliation: Where the RCM platform cannot reliably recognize clean payments or denials, maintain an independent tracking log of claims outside the system—verify timely submission in the Partnership HealthPlan and Health Net portals, reconcile payments and denials against actual bank deposits, and prompt Sprite Health to correct repayment values and discrepancies. Vendor & Platform Oversight: Collaborate with external engineering and account management teams (Sprite Health) to troubleshoot dashboard sync issues, identify reporting discrepancies, and advocate for necessary system updates. Workflow Optimization: Build and refine weekly/monthly management checklists to ensure zero-variance tracking between active clinical enrollments and final month-end claim sign-offs. Create and Update Revenue Cycle Dashboards: Ensure dashboards are updated for use by Vayu’s finance and accounting team. Required Qualifications & Experience Medi-Cal Billing Expertise: Deep, hands-on knowledge of California Medi-Cal billing frameworks, with specific, preferred experience in Enhanced Care Management (ECM) and ECM+ (Diabetes Management) codes and reimbursement structures. Advanced Claims Auditing: Proven track record of identifying root causes for $0 payments, missing claims, and unexplained payer denials. Portal Proficiency: Direct experience navigating and submitting disputes through California Managed Care Plan portals (specifically Partnership HealthPlan of California and Health Net). Experience with RCM/EHR systems. Experience working with evolving EHR/RCM dashboards required. Data & Tech Savvy: Strong data analysis skills (Excel mastery is a must). You must be comfortable managing data manually (or working with the Vayu team to create automations) when system automations lag. Communication: Exceptional communication skills to bridge the gap between clinical operations, billing vendors, and payers to drive prompt issue resolution. #J-18808-Ljbffr Vayu Health