Job
Description
In this role as a RCM / Medical Billing Specialist, you will be responsible for providing Level 1 and Level 2 support for U.S. Healthcare Revenue Cycle Management (RCM) workflows. Your analytical skills and domain expertise will be crucial in identifying and resolving claim discrepancies, logic or mapping issues in EDI 835/837 transactions, and collaborating with clearinghouses. Communication with U.S. clients and maintaining compliance with HIPAA guidelines will also be key aspects of your role. **Key Responsibilities:** - Provide Level 1 and Level 2 support for RCM workflows, including claim discrepancies. - Analyze EDI 835/837 transaction data to identify and resolve logic or mapping issues. - Collaborate with clearinghouses (Waystar, Availity, Change Healthcare) to document recurring issues, perform root cause analysis, and 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:** - Strong understanding of U.S. Healthcare RCM including charge entry. - 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). **Customer Support Competencies:** - Analytical thinker who investigates workflow issues instead of surface-level resolutions. - Excellent written and verbal communication skills tailored for non-technical audiences. - Ability to collaborate with internal product or development teams for technical fixes and process improvements. - Proven record of maintaining high CSAT scores and quick response times. **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). In this role as a RCM / Medical Billing Specialist, you will be responsible for providing Level 1 and Level 2 support for U.S. Healthcare Revenue Cycle Management (RCM) workflows. Your analytical skills and domain expertise will be crucial in identifying and resolving claim discrepancies, logic or mapping issues in EDI 835/837 transactions, and collaborating with clearinghouses. Communication with U.S. clients and maintaining compliance with HIPAA guidelines will also be key aspects of your role. **Key Responsibilities:** - Provide Level 1 and Level 2 support for RCM workflows, including claim discrepancies. - Analyze EDI 835/837 transaction data to identify and resolve logic or mapping issues. - Collaborate with clearinghouses (Waystar, Availity, Change Healthcare) to document recurring issues, perform root cause analysis, and 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:** - Strong understanding of U.S. Healthcare RCM including charge entry. - 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). **Customer Support Competencies:** - Analytical thinker who investigates workflow issues instead of surface-level resolutions. - Excellent written and verbal communication skills tailored for non-technical audiences. - Ability to collaborate with internal product or development teams for technical fixes and process improvements. - Proven record of maintaining high CSAT scores and quick response times. **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).
