RCM Specialist

We are looking for an experienced and detail-oriented US Revenue Cycle Management (RCM) Specialist with comprehensive hands-on expertise across the entire medical billing lifecycle. This includes charge entry, claims processing, accounts receivable (AR) management, 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 applicable channels.
- Review claims to identify errors, rejections, or missing information prior to submission.
- Manage AR aging reports and proactively follow up on outstanding balances in 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 through phone calls 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 other 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.
- Coordinate 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

- 4–5 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.
- Hands-on 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.
- Solid 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.
- High attention to detail, strong organizational skills, and ability to manage multiple accounts and priorities effectively.
- Ability to work independently while consistently meeting productivity, quality, and collection targets.

Preferred Qualifications

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

This position requires in-person work, offering the opportunity to collaborate closely with healthcare providers and US clients to ensure smooth revenue cycle operations. If you are a motivated professional with a thorough understanding of US RCM processes and a commitment to accuracy and efficiency, this role is an excellent fit.