RCM Expert (Medical Billing)

We are looking for a skilled Revenue Cycle Management (RCM) Expert with a strong background in Medical Billing to manage and enhance the entire revenue cycle for US healthcare providers. The ideal candidate will have practical experience in medical billing, claims management, insurance follow-ups, denial resolution, accounts receivable (AR), payment posting, and revenue optimization. This role focuses on identifying revenue leakage, resolving complex billing challenges, improving collections, and ensuring timely and accurate claim reimbursements.

Key Responsibilities
Manage and oversee the full Revenue Cycle Management process, including charge entry, claim submission, payment posting, AR follow-up, denial management, and account reconciliation. Review and resolve rejected, denied, and underpaid claims efficiently to maximize revenue recovery. Conduct detailed AR analysis, prioritizing accounts based on aging and recovery potential. Perform insurance verification and eligibility checks when necessary. Follow up with insurance companies on outstanding claims and unpaid balances to ensure timely payments. Investigate claim denials to identify root causes and implement corrective actions to prevent recurrence. Handle complex billing and reimbursement issues with various insurance payers. Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure accurate payment posting and contractual adjustments. Identify issues related to coding, authorization, eligibility, documentation, and billing that impact reimbursement. Focus on high-value and aging AR accounts to optimize collections. Coordinate with internal teams, healthcare providers, and insurance companies to resolve billing discrepancies. Maintain accurate documentation of follow-ups, claims, appeals, and payer communications. Prepare and analyze RCM reports, including AR aging, denial trends, collection performance, and payment variances. Monitor payer trends and recommend process improvements to enhance revenue cycle efficiency. Assist in developing strategies to improve clean claim rates and reduce days in AR. Ensure compliance with healthcare billing regulations and client requirements. Provide training and guidance to junior RCM staff as needed. Meet assigned productivity, quality, and collection targets consistently.

Required Qualifications
Bachelor’s degree in Business Administration, Healthcare Management, Finance, or a related field is preferred. A minimum of 4 to 6 years of hands-on experience in US medical billing and revenue cycle management. Strong knowledge of the complete medical billing lifecycle, including AR, denials, appeals, payment posting, and claims follow-up. In-depth understanding of US insurance payers such as Medicare, Medicaid, Commercial insurance, and Workers' Compensation. Familiarity with CPT, HCPCS, ICD-10, modifiers, and medical billing terminology. Experience working with EOBs, ERAs, clearinghouses, and payer portals. Excellent analytical and problem-solving skills. Strong communication and negotiation abilities. Proficiency in MS Excel and medical billing/RCM software. Ability to manage multiple accounts simultaneously and meet strict deadlines. High attention to detail and commitment to accuracy.

Preferred Qualifications and Benefits
Certifications such as CPC, CPB, CPMA, CCA, or other relevant medical billing and coding credentials are advantageous. The position offers a competitive salary package within a professional and growth-oriented work environment. Opportunities for career development, performance-based incentives, and training programs are provided. This role offers direct exposure to US healthcare and medical billing processes. The position requires in-person attendance at the office located on Murree Road, Rawalpindi, with night shift hours. Candidates should be able to commute accordingly.

If you are a dedicated RCM professional with expertise in US medical billing and a passion for optimizing revenue while resolving complex billing issues, we encourage you to apply. During the application process, candidates will be asked about current and expected salary, notice period, commute feasibility for night shifts, and relevant RCM experience.