RCM Speciaist

We are looking for an experienced RCM Specialist with a focus on Urgent Care to oversee the complete medical billing and collections process for busy urgent care centers across the United States. This role requires expertise in clean charge entry, urgent care-specific coding including S-codes and E/M modifiers, real-time insurance coverage verification, and proactive claim denial resolution to optimize clinic revenue. The ideal candidate will excel in a fast-paced environment and possess a strong understanding of urgent care coding nuances, workers' compensation billing, and commercial and government payer regulations.

Key Responsibilities

Urgent Care Charge Creation & Coding Verification
Review and process daily superbills, EHR charts, and visit logs for a high volume of urgent care encounters. Assign and verify CPT codes for Evaluation & Management services (E/M 99202–99215), urgent care-specific S-codes (such as S9088, S9083), minor surgical procedures like laceration repairs and abscess drainage, and ancillary services including in-house labs, rapid COVID/Flu tests, and X-rays. Apply appropriate modifiers such as Modifier 25 for E/M with minor procedures, Modifier 59/XS for distinct procedural services, and TC/26 for radiology, ensuring compliance with NCCI edits. Accurately map Place of Service codes (POS 20 for Urgent Care Facility or POS 11) based on payer guidelines. Separate and bill Occupational Medicine/Workers' Compensation encounters following employer or carrier protocols distinct from group health insurance.

Eligibility Verification & Front-End Clean Claim Scrubbing
Audit patient demographic and insurance information collected at intake to confirm active eligibility, correct primary and secondary payer order, and proper copay/deductible collection. Scrub claims to identify missing or invalid rendering NPIs, supervising physician linkages for PA/FNP providers, absent authorization numbers, or missing diagnosis pointers before claim submission. Maintain a first-pass clean claim rate of 98% or higher.

Accounts Receivable (AR) & Urgent Care Denial Management
Manage aging AR reports across commercial payers (including BCBS, Aetna, Cigna, UHC, Humana), Medicare, and state Medicaid programs. Investigate, appeal, and resolve common urgent care claim denials such as missing or unbundled procedural modifiers, non-covered urgent care S-codes, bundled facility fees, rendering provider credentialing issues, out-of-network or authorization-required rejections, coordination of benefits conflicts, and timely filing denials. Communicate with payer representatives via phone and online portals (Availity, NaviNet, Medicare PECOS) to verify claim status and request reprocessing. Prepare and submit formal written appeals supported by clinical notes, chart documentation, and medical necessity evidence.

Payment Posting & Balance Resolution
Post electronic remittance advices (ERA/835) and manual explanation of benefits (EOBs), reconciling payments against contracted fee schedules. Identify payment shortfalls or incorrect contractual adjustments and initiate underpayment appeals. Accurately allocate patient balances such as copays, coinsurance, and unmet deductibles to patient billing statements.

Collaboration & Reporting
Maintain detailed call notes and tracking logs within the Practice Management and EHR systems. Prepare weekly AR aging summaries, denial trend reports, and clean claim tracking metrics for clinic leadership. Collaborate closely with front-desk staff to address eligibility or intake errors that impact billing accuracy.

Required Qualifications
- 3 to 5 years of direct experience in US Healthcare Revenue Cycle Management and Medical Billing, including at least 1 year of Urgent Care experience.
- Hands-on experience with AdvancedMD practice management software.
- Excellent verbal and written communication skills in English, with strong telephone negotiation abilities when dealing with US insurance representatives.

Compensation and Work Schedule
The position offers competitive pay ranging from Rs100,000 to Rs130,000 per hour, with an expected workweek of 40 hours. This is an in-person role requiring presence at the designated work location.

This opportunity is ideal for a detail-oriented professional who thrives in a dynamic environment and is committed to maximizing revenue cycle efficiency for urgent care operations.