RCM Expert

We are looking for a skilled and detail-oriented US Revenue Cycle Management (RCM) Specialist with comprehensive hands-on experience throughout the medical billing lifecycle. This includes expertise in Charge Entry, Claims Processing, Accounts Receivable (AR), Payment Posting, Denial Management, and Insurance Follow-ups. The ideal candidate will have a strong understanding of US healthcare billing practices, payer requirements, clearinghouses, medical coding guidelines, and RCM workflows. They should be adept at identifying billing issues, resolving claims efficiently, and supporting timely revenue collection to optimize financial performance.

Key Responsibilities

- Perform daily charge entry, generate claims, review for accuracy, and ensure timely submission via EDI and other relevant channels.
- Identify and correct claim errors, rejections, and missing information prior to submission to minimize denials.
- Manage AR aging reports and proactively follow up on outstanding balances across 30+, 60+, 90+, and 120+ day buckets.
- Accurately post ERAs and EOBs, including handling deductibles, co-pays, co-insurance, contractual adjustments, and write-offs.
- Investigate claim denials and rejections by identifying root causes, submitting corrected claims, and preparing appeals when necessary.
- Conduct regular follow-ups with Medicare, Medicaid, and commercial payers such as BCBS, Aetna, Cigna, and Humana through 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 prevent front-end billing issues.
- Process patient statements and respond professionally to patient billing inquiries in line with practice policies.
- Maintain accurate billing records while adhering to HIPAA, patient privacy, and applicable 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 process improvements to reduce denials, enhance collections, and increase overall RCM efficiency.

Required Qualifications

- 4–5 years of hands-on experience in US RCM, including medical billing, AR follow-up, payment posting, and denial management.
- Strong understanding of the complete US medical billing and RCM lifecycle.
- Proficiency 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.
- Solid knowledge of CPT, ICD-10, HCPCS, modifier guidelines, NCCI edits, and payer-specific requirements.
- Proficient 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 meeting assigned productivity, quality, and collection targets.

Preferred Qualifications

- Bachelor’s degree in Healthcare Administration, Business Administration, or a related field is preferred.

Work Location

This position requires in-person attendance at the designated work site.

This role offers an excellent opportunity for a motivated RCM professional to contribute to the financial health of healthcare providers by ensuring efficient and accurate revenue cycle processes.