Job Description & Details
This is a specialized revenue cycle role focused on complex specialty pharmacy claims within oncology, rare disease, and cell and gene therapy lines. You will spend your days untangling payer denials, wrestling with clearinghouse rejections, and making sure millions in high-value medical claims actually get reimbursed. If you like detective work combined with high-volume financial operations, this gig keeps you on your toes.
What You'll Actually Be Doing
Your day-to-day involves living inside billing systems like CareTend and WayStar, scrubbing claims before they go out the door, and chasing down stubborn unpaid balances. You'll constantly pivot between analyzing root causes for claim rejections, submitting appeals, coordinating with internal clinical and compliance teams, and handling manufacturer chargebacks. It's a high-accountability environment where missing a payer rule or a filing deadline directly impacts cash flow for life-saving therapies.
The Core Tech Stack
To survive here, you need a strong working knowledge of medical billing principles, ERA/EOB interpretation, and revenue cycle mechanics. Experience navigating platforms like CareTend, WayStar, CPR+, or SAP is a massive plus, as is advanced proficiency in Excel for tracking aging reports and handling data reconciliations. The systems are complex because the payers are difficult, so technical fluency with healthcare clearinghouses and enterprise billing software is non-negotiable.
Interview Expectations
Expect the hiring manager to throw a complex denial scenario at you, asking you to walk step-by-step through how you would investigate a prior-authorization rejection for an ultra-orphan drug. They are secretly testing your resilience, attention to detail, and ability to communicate cross-functionally without dropping the ball. They also want to see how you handle shifting payer guidelines, so be ready to share a real-world example of how you caught a recurring billing error and fixed it at the source.
Application Advice
Make sure your resume doesn't just list your past job duties, but highlights your hard metrics around denial resolution rates, days in A/R, and high-volume claim processing. Explicitly weave keywords like CareTend, WayStar, denial management, chargebacks, and specialty pharmacy reimbursement into your experience bullets to ensure you clear the ATS filters. Show them you speak the language of complex healthcare revenue cycles from day one.