RCM Experts

We are looking for a skilled and detail-oriented US Revenue Cycle Management (RCM) Specialist with extensive hands-on experience throughout the medical billing lifecycle. The ideal candidate will be proficient in Charge Entry, Claims Processing, Accounts Receivable (AR), Payment Posting, Denial Management, and Insurance Follow-ups. A strong understanding of US healthcare billing practices, payer requirements, clearinghouses, medical coding guidelines, and RCM workflows is essential. This role requires the ability to identify billing issues, resolve claims efficiently, and support timely revenue collection to ensure optimal financial performance.

Key Responsibilities

- Perform daily charge entry, claim generation, claim review, and timely submission via EDI and other applicable channels.
- Review claims for errors, rejections, and missing information prior to submission.
- Manage AR aging and conduct proactive follow-ups 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, identify root causes, submit corrected claims, and prepare appeals as 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 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, 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.
- Exceptional attention to detail, organizational skills, and the ability to manage multiple accounts and priorities.
- 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.
- Competitive monthly salary ranging from Rs80,000 to Rs120,000.
- This position requires in-person work, providing an opportunity to collaborate closely with the team and clients.

This role is ideal for candidates who are proactive, detail-focused, and committed to improving revenue cycle processes within a dynamic healthcare environment.