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.