Posted 6 days ago 17 views
We are seeking a detail-oriented and experienced US Revenue Cycle Management (RCM) Specialist with a strong background in the full medical billing lifecycle. The ideal candidate will have hands-on expertise in Charge Entry, Claims Processing, Accounts Receivable (AR), Payment Posting, Denial Management, and Insurance Follow-ups. A thorough understanding of US healthcare billing practices, payer requirements, clearinghouses, medical coding guidelines, and RCM workflows is essential. This role focuses on identifying billing issues, resolving claims efficiently, and supporting timely revenue collection to optimize financial performance.
Key Responsibilities
Perform daily charge entry, generate and review claims, ensuring timely submission through EDI and other relevant channels. Review claims meticulously to identify errors, rejections, or missing information before submission. Manage AR aging by proactively following up on outstanding balances across 30+, 60+, 90+, and 120+ day buckets. Accurately post ERAs and EOBs, including deductibles, co-pays, co-insurance, contractual adjustments, and write-offs. Investigate claim denials and rejections, determine root causes, submit corrected claims, and prepare appeals when necessary. Conduct regular follow-ups with Medicare, Medicaid, and commercial payers such as BCBS, Aetna, Cigna, and Humana via phone and payer portals. Monitor and resolve clearinghouse rejections using platforms like Availity, Waystar, Change Healthcare, or similar systems. Verify patient eligibility, insurance benefits, and prior authorization requirements to reduce front-end billing issues. Process patient statements and respond professionally to patient billing inquiries in accordance with practice policies. Maintain accurate billing records while adhering to HIPAA, patient privacy, and relevant healthcare regulations. Apply knowledge of CPT, ICD-10, HCPCS, modifiers, NCCI edits, and payer-specific billing guidelines when reviewing and resolving claims. Prepare daily, weekly, and monthly reports covering key RCM metrics, collections, AR trends, denial rates, and overall performance. Collaborate with healthcare providers, clinical teams, and US clients to resolve documentation and billing-related issues. Identify workflow gaps and recommend improvements to reduce denials, enhance collections, and increase overall RCM efficiency.
Required Qualifications
4 to 5 years of hands-on experience in US RCM, medical billing, AR follow-up, payment posting, and denial management. Strong understanding of the complete US medical billing and RCM lifecycle. Experience with EHR/Practice Management systems such as eClinicalWorks, Kareo, athenahealth, AdvancedMD, Practice Fusion, or similar platforms. Familiarity with clearinghouses including Availity, Waystar, Change Healthcare, and insurance payer portals. In-depth knowledge of CPT, ICD-10, HCPCS, modifier guidelines, NCCI edits, and payer-specific requirements. Proficiency in MS Excel, including Pivot Tables, VLOOKUP, and basic reporting/data analysis. Excellent written and verbal English communication skills with professional phone etiquette for interacting with US insurance representatives and clients. Strong analytical and problem-solving abilities to investigate complex denials and billing discrepancies. Exceptional attention to detail, organizational skills, and the ability to manage multiple accounts and priorities effectively. Ability to work independently while consistently meeting assigned productivity, quality, and collection targets.
Preferred Qualifications
A Bachelor’s degree in Healthcare Administration, Business Administration, or a related field is preferred.
Work Location
This position requires in-person attendance.
This role offers an excellent opportunity for an experienced RCM professional to contribute to efficient revenue cycle operations within a dynamic healthcare environment.
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