RCM Operations Analyst

🕒 May 22

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $62k - $83k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Cartwheel

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

📚 Education

🌍 Social Impact

Healthcare Insurance • Education • Social Impact

Cartwheel is a trusted mental health partner to schools, helping children and families navigate mental health challenges. They provide support through Multi-Tiered Systems of Support aimed at early intervention. Cartwheel prioritizes rapid access to mental health care, offering evidence-based treatment without waitlists. Their comprehensive care includes individual therapy, group therapy, medication management, and parental guidance, typically lasting two to six months. They emphasize equitable, culturally sensitive care with a bilingual staff and are committed to affordability, working with families regardless of insurance status. Cartwheel collaborates closely with schools to integrate mental health support into educational environments and to address student and staff mental health crises. Their goal is to empower students to thrive in school, at home, and in life by providing immediate and accessible mental health resources.

📋 Description

• Conduct structured analysis of denial and rejection data to identify root causes, payer patterns, and filing limit exposure • Move beyond rework — trace denial and rejection spikes to upstream workflow, documentation, or submission failures and drive fixes at the source • Build and maintain AR aging trend tracking and recoverable revenue opportunity analysis • Execute claim corrections, resubmissions, and payer follow-up as a hands-on operational contributor • Build and maintain operational dashboards (Looker preferred) that give RCM leadership real-time visibility into denial volume, payer performance, and AR trends • Produce clear, prioritized findings from claim-level data using pivot tables, formulas, and BI tooling • Design reporting outputs so findings are actionable and accessible to non-billing stakeholders — not just data-literate audiences • Translate billing logic, payer-specific rules, and denial patterns into written, maintainable SOPs • Build operational workflow guides prioritized by highest-volume and highest-denial-rate categories first • Ensure documentation is usable by team members without direct guidance, so operational knowledge scales beyond any one person • Partner with clinical teams to identify upstream documentation or workflow gaps contributing to denials and rejections • Validate billing logic and payer requirements in collaboration with RCM leadership • Communicate findings and recommendations in plain language to non-billing stakeholders including clinical and operations partners • Support training and internal knowledge base development as the operational RCM subject matter resource

🎯 Requirements

• 3+ years of hands-on RCM operations experience with direct responsibility for denial management, rejection analysis, and billing workflow improvement • Strong analytical skills — ability to extract prioritized, revenue-framed findings from large and complex claim-level datasets • Experience building or actively maintaining operational dashboards (Looker preferred; comparable BI tools acceptable) • Proficiency with pivot tables and Excel or Google Sheets for claim data manipulation and analysis • In-depth knowledge of multiple insurance payer environments — Medicaid MCO experience strongly preferred; commercial payer depth (especially BCBS) also required • Demonstrated root cause instinct — able to trace denial and rejection patterns to workflow or documentation failures, not just surface-level category identification • Process improvement mindset with strong cross-functional communication skills and comfort working in a remote, async-first environment

🏖️ Benefits

• Competitive cash compensation between $62,000 to $83,000 • Equity ownership stake in the company • High-quality health insurance with a $0 monthly premium option for employees • Dental, Vision, and Employer-Sponsored Life Insurance • 4 weeks of paid PTO (3 weeks any time + 1 week office closure in December) • Sick Leave + Holidays • 401K with 2% employer match • Team-based culture with mission-driven colleagues who will go to bat for you