RCM / Medical Billing Specialist | WFH

Key Responsibilities

• Provide Level 1 and Level 2 support for RCM workflows, including claim submission, charge entry, payment posting, and denial management.
• Troubleshoot payer rejections, configuration errors, and ERA posting discrepancies.
• Analyze EDI 835/837 transaction data to identify and resolve logic or mapping issues.
• Collaborate with clearinghouses (Waystar, Availity, Change Healthcare) to address payer-related discrepancies.
• Document recurring issues, perform root cause analysis, and work with internal teams to prevent recurrence.
• Communicate effectively with U.S. clients, ensuring clear, solution-oriented updates and documentation.
• Maintain compliance with HIPAA and 42 CFR Part 2 guidelines while handling sensitive data.

Required Skills s Domain Expertise

• Strong understanding of U.S. Healthcare RCM including charge entry, payment posting, denial analysis, and AR follow-up.

• In-depth knowledge of payer rules (Medicare, Medicaid, commercial payers).

• Working knowledge of CPT, ICD-10, HCPCS, modifiers, and ERA/EDI 835-837 transactions.

• Demonstrated ability to identify root causes behind denials and system-level billing issues.

Technical Competencies

• Hands-on experience with one or more medical billing systems: CollaborateMD, Kareo, AdvancedMD, Athenahealth, eClinicalWorks, DrChrono, NextGen, PracticeSuite, or similar.

• Experience using clearinghouse portals such as Waystar, Availity, and Change Healthcare.

• Familiarity with ticketing tools like Zendesk, Freshdesk, or Salesforce Service Cloud.

• Strong Excel skills for reporting, validation, and analysis (pivot tables, lookups).

Qualifications

• Bachelor’s Degree (preferably in Commerce, Healthcare Administration, or related field).

• 3–6 years of relevant experience in U.S. Healthcare RCM.

• Certifications preferred: HIPAA Awareness, AAPC CPC (in progress or completed).

Job Types: Full-time, Permanent

Pay: ₹200,000.00 - ₹800,000.00 per year

Benefits:

• Provident Fund

Work Location: In person