Revenue Cycle Operations Specialist

Revenue Cycle Operations Specialist UpsideHom, Inc. Fort Lauderdale, FL Job Details Full-time $65,000 - $75,000 a year 1 day ago Benefits Paid holidays Health insurance Dental insurance Paid time off Vision insurance Qualifications Appeals Financial data reconciliation Operations management Managed care Insurance claim appeals processing Mid-level ICD-10 Salesforce Cloud HCPCS Medical insurance appeals management Payment posting in medical billing systems CRM system proficiency Root cause analysis Month-end close Escalation handling 2 years

Full Job Description About Upside:

Upside is a housing-focused care partner helping people experiencing housing instability take the next step toward stability. We partner with health plans and care organizations to identify members at risk, build a clear housing plan, and drive the work forward through placement and stabilization. Upside owns the entire housing process from start to finish. Our team engages members, coordinates with local providers and community resources, manages logistics and documentation, and stays involved until the issue is resolved. Our approach is human-first and outcome-driven, measured by real results like stable housing, completed moves, safer living environments, and successful transitions. About the

Opportunity:

Upside is hiring a Revenue Cycle Operations Specialist to support the full claims lifecycle across multiple Medicaid managed care plans. This role sits at the intersection of service delivery, payer billing, and revenue operations, helping ensure eligible services are billed accurately, claims are submitted on time, and revenue gaps are identified and resolved quickly. This is a detail-heavy, operational role for someone who understands how Medicaid billing works in the real world: payer-specific rules, authorization windows, claim edits, denials, billing frequencies, and month-end reconciliation. You'll work primarily in Salesforce, payer/member portals, and Stedi, our electronic claims platform, to monitor claim readiness, resolve issues, and keep revenue cycle workflows moving across multiple programs and states.

Work Location and Schedule:

Full-time, fully remote (must be based in the United States) Coverage aligned to Eastern or Central time Schedule is starting

Monday-Friday What You'll Do:

Manage day-to-day revenue cycle operations across multiple Medicaid managed care plans, including claim readiness, submission tracking, denial follow-up, payment posting, and reconciliation Monitor eligible service events and identify missing, unbilled, or underbilled claims to help close revenue gaps Review payer-specific billing rules, fee schedules, authorization requirements, billing frequencies, and contract terms to ensure claims are submitted accurately Track claim status across Stedi, Salesforce, payer portals, and internal reports Identify and resolve claim edits, rejections, denials, and payment issues; draft and submit appeals or corrected claims as needed Review denial codes and claim trends to understand root causes and flag recurring issues to leadership Partner with Operations and service delivery teams to ensure member records, authorizations, service documentation, and billing inputs support clean claims Monitor for issues that may prevent billing, including expired authorizations, eligibility gaps, missing documentation, or services that do not meet payer rules Support weekly and monthly billing workflows, including payer-specific claim cycles, month-end close, aging review, and collections reporting Validate procedure codes, modifiers, diagnosis codes, and billing rules against Medicaid managed care plan requirements Maintain clean, accurate tracking of claims activity, denials, payments, and open revenue cycle follow-ups Help improve revenue cycle processes as Upside scales across new programs, states, and payer contracts

What We're Looking For:

2+ years of experience in medical billing, claims operations, or revenue cycle management, ideally in a Medicaid or managed care environment Hands-on experience working with claims, denials, eligibility, authorizations, payment follow-up, or month-end revenue cycle workflows Strong understanding of Medicaid managed care billing, including payer-specific rules, claim submission requirements, and reimbursement timelines Familiarity with HCPCS Level II procedure codes, ICD-10-CM diagnosis coding, and Z-codes for SDOH-related services Working knowledge of

CMS-1500

claims and how procedure codes, modifiers, diagnosis codes, authorizations, and service documentation connect in the billing process Comfort reviewing claim and denial codes, identifying patterns, and escalating issues with clear context Experience working across multiple payers, plans, states, or contract requirements at the same time Strong attention to detail and comfort managing high-volume lists, reports, and follow-ups without letting items slip through the cracks Proficiency in spreadsheets and comfort working across multiple systems; Salesforce experience is a strong plus Experience with clearinghouses, payer portals, or claims platforms; Stedi experience is a plus Ability to work independently, prioritize competing deadlines, and escalate issues appropriately Familiarity with prior authorization, eligibility verification, housing-related services, long-term care transition programs, or SDOH billing is a plus

Compensation and Benefits:

Salary:

$65,000 - $75,000 Medical, dental, and vision coverage Paid time off and company holidays Upside is proud to be an equal opportunity employer. We do not discriminate in hiring or any employment decision based on race, color, religion, national origin, age, sex, marital status, ancestry, disability, genetic information, veteran status, gender identity or expression, sexual orientation, pregnancy, or other applicable legally protected characteristic. Upside is also committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. If you have a disability or special need that requires accommodation, please let us know.