About GEM HEALTH:

GEM HEALTH is determined to make healthcare, and all aspects of receiving the care a patient needs, simpler for everyone.  Patients deserve simple, hassle free and affordable care that works. Clinicians should focus on providing care, not administering the business of care. Insurance companies and employers should have confidence in the partners they choose; partners that are focusing on reducing costs for everyone and driving positive outcomes.

GEM HEALTH is the company and platform driving towards these ambitious goals in specialty care. Specialty care picks up where Primary Care hands off and is their partner to help diagnose, treat, and support patients at scale.  GEM’s first offering, GEM SLEEP, will be the first patient focused solution that solves the most pressing problems in Sleep Apnea – one partner to help navigate the end-to-end process in an accessible and affordable manner.

Come help us build the platform that consumers truly want, but rarely expect and receive, for their health.

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Role Overview:

The Revenue Cycle Analyst is responsible for ensuring the financial success of the organization by managing prior authorization processes, analyzing claim denials, and implementing recovery strategies. The success of the RCM department depends on the skillset of the RCM Analyst. This role requires expertise in medical billing processes, insurance verification, and knowledge of payer reimbursement methodologies to optimize revenue capture and minimize revenue loss.

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Key Responsibilities:

Prior Authorization Management:

-  Review and submit prior authorization requests to insurance payers.

-  Track and follow up on authorization approvals, ensuring timely completion.

-  Communicate with providers and patients regarding authorization status and potential delays.

-  Maintain up-to-date knowledge of payer requirements and authorization policies.  

Claim Denial Review & Recovery:

-  Investigate and analyze denied or underpaid claims to determine root causes.

-  Develop and implement strategies to appeal and recover denied claims.

-  Collaborate with billing teams, providers, and payers to resolve denial issues.

-  Track trends in denials and recommend process improvements to reduce future occurrences.

‍Revenue Cycle Analysis & Reporting:

-  Monitor key performance indicators (KPIs) related to revenue cycle functions.

-  Generate reports to identify patterns in authorization delays and claim denials.

-  Work closely with leadership to implement process improvements and maximize reimbursement.

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Required Qualifications:

•  Bachelor’s degree in healthcare administration, business, or a related field (preferred) or, 5+ years of experience in medical billing, revenue cycle or patient access can be used in lieu of degree.

•  Minimum of 2-3 years of experience in revenue cycle management, prior authorizations, or medical billing.

•  Knowledge of insurance payer policies, CPT/ICD coding, and payer reimbursement processes.

•  Strong analytical and problem-solving skills with attention to detail.

•  Proficiency in EHR and billing software (experience with Niko EHR is a plus).

•  Excellent communication and interpersonal skills for collaboration with internal and external stakeholders.

Preferred Qualifications  

•  Customer service and/or account management experience.

•  Experience with billing for durable medical equipment, sleep therapies and/or remote patient monitoring programs