About the Role
We are looking for a detail-oriented RCM Specialist to manage healthcare revenue cycle activities, including claims processing, accounts receivable follow-up, denial management, payment posting, and reimbursement tracking. The ideal candidate will have hands-on experience with US healthcare RCM processes and a strong focus on accuracy, productivity, and timely revenue recovery.
Key Responsibilities
- Manage end-to-end revenue cycle activities, including claims submission, claim status follow-up, payment posting, and accounts receivable management.
- Follow up with insurance companies and payers regarding outstanding claims, delayed payments, and claim rejections.
- Investigate claim denials, identify root causes, and coordinate corrective actions and resubmissions.
- Maintain accurate documentation of payer interactions, claim updates, and follow-up activities.
- Monitor aging reports and prioritize outstanding claims to improve collections and reduce AR days.
- Identify recurring billing issues and recommend process improvements.
- Meet daily productivity, quality, collection, and turnaround-time targets.
- Collaborate with team leads and managers to resolve complex claims and escalate payment issues.
- Follow applicable healthcare regulations, HIPAA requirements, and company data privacy policies.
- Support process standardization and the adoption of automation tools to improve operational efficiency.
Required Qualifications
- 6+ years of experience in US healthcare RCM or medical billing.
- Strong knowledge of insurance claims, payer follow-up, AR management, and denial resolution.
- Familiarity with US healthcare insurance processes, including commercial payers and government programs such as Medicare and Medicaid.
- Experience using practice management systems, billing platforms, and claim management tools.
- Good analytical, communication, documentation, and problem-solving skills.
- Ability to work with productivity and quality targets in a fast-paced environment.
- Willingness to work US business hours or rotational shifts, as required.
Preferred Skills
- Experience with denial prevention and revenue recovery.
- Knowledge of medical billing workflows, EOBs, ERAs, and claim adjustment codes.
- Exposure to RCM automation, RPA, AI tools, or workflow optimization.
- Familiarity with HIPAA-compliant handling of protected health information (PHI).
Key Performance Indicators (KPIs)
- AR follow-up productivity and collections performance.
- Denial resolution and recovery rate.
- Claim accuracy and quality scores.
- Reduction in outstanding AR and aging claims.
- Adherence to turnaround times and process compliance.
What We Offer
- An opportunity to contribute to a growing healthcare technology and RCM organization.
- Exposure to modern automation and AI-driven healthcare workflows.
- A collaborative environment with opportunities for professional development.
