Revenue Cycle Management 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), Payment Posting, Denial Management, and Insurance Follow-ups. The ideal candidate will possess 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, claim generation, claim review, and ensure timely submission through EDI and other applicable channels.
- Review claims thoroughly to identify errors, rejections, and missing information prior to 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 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 ensuring compliance with 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.
- 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 Revenue Cycle Management, 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.
- Strong 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 skills with the ability 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 meeting assigned productivity, quality, and collection targets.

Preferred Qualifications and Benefits

- Bachelor’s degree in Healthcare Administration, Business Administration, or a related field is preferred.
- Opportunity to work in person, fostering direct collaboration with teams and clients.
- Competitive pay starting from Rs120,000.00 per month.

This role is ideal for professionals seeking to leverage their US RCM expertise in a dynamic environment focused on accuracy, compliance, and revenue optimization.