RCM Speciaist

We are looking for an experienced AR Specialist to manage the complete medical billing and collections process for high-volume urgent care centers across the United States. This role involves ensuring accurate charge entry, applying urgent care-specific coding such as S-codes and E/M modifiers, verifying real-time insurance coverage, and actively resolving claim denials to optimize clinic revenue. The ideal candidate will excel in a fast-paced environment and have a strong understanding of urgent care coding complexities, 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 urgent care encounters. Assign and verify CPT codes for Evaluation & Management (E/M 99202–99215), urgent care-specific S-codes (e.g., S9088, S9083), minor surgical procedures such as laceration repairs and abscess drainage, and ancillary services including in-house labs, rapid COVID/Flu tests, and X-rays. Apply appropriate modifiers like 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) according to payer guidelines. Separate and bill Occupational Medicine and Workers’ Compensation encounters under correct employer or carrier protocols versus group health insurance.

Eligibility Verification & Front-End Clean Claim Scrubbing
Audit patient demographic and insurance intake data collected by front desk staff 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, missing authorization numbers, or absent diagnosis pointers before claim submission. Maintain a first-pass clean claim rate target of 98% or higher.

Accounts Receivable (AR) & Urgent Care Denial Management
Manage aging AR reports for 30, 60, 90, and 120+ days across commercial payers (BCBS, Aetna, Cigna, UHC, Humana), Medicare, and Medicaid. 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 denials, coordination of benefits, and timely filing rejections. 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 and medical necessity documentation.

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

Collaboration & Reporting
Maintain detailed call notes and tracking logs within the Practice Management (PM) and EHR systems. Prepare weekly AR aging summaries, denial trend reports, and clean claim tracking metrics for clinic leadership review. Work closely with front desk staff to provide feedback on 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 Advanced MD practice management software.
- Excellent verbal and written English communication skills, with strong telephone negotiation abilities when interacting with US insurance representatives.

Compensation and Work Location
The position offers a monthly salary range of Rs100,000 to Rs130,000. This is an in-person role requiring attendance at the designated work location.

This opportunity is ideal for professionals who are detail-oriented, proactive in denial management, and skilled in urgent care billing nuances. If you thrive in a dynamic environment and are committed to maximizing revenue cycle efficiency, we encourage you to apply.