Nucleon Health Private Limited

As an RCM Specialist at Nucleon Health, your role involves optimizing revenue cycle processes, minimizing receivables, and ensuring accurate billing and claim management. You will be responsible for eligibility verification, denial management, medical coding, and automation of billing processes to maximize revenue and enhance customer satisfaction. Key Responsibilities: - Ensure medical coding compliance by adhering to ICD-10 standards, reducing AR backlogs, and improving provider documentation. - Manage claims and accounts receivable transparently, focusing on revenue recovery and implementing denial management strategies. - Utilize process automation tools like EDI for electronic claim submission, ensuring efficient transactions through EFT and ERA enrollment. - Develop and implement denial management strategies to promptly address denials, maintain a high Clean Claim Ratio (CCR), and track frequent denials. - Prioritize patient satisfaction by reviewing patient ledgers, ensuring accurate billing, and providing real-time resolution of billing queries. - Collaborate with medical billing specialists to provide consultative support, improve collections, reduce AR days, and enhance ROI. Qualifications & Skills: - Bachelor's degree in Healthcare Administration, Finance, or a related field. - Proven experience in medical billing and revenue cycle management. - Strong understanding of insurance guidelines, LCD/NCD policies, and coding standards. - Proficiency in RCM software, EDI enrollment, and claim processing automation. - Excellent analytical and problem-solving skills.,