📢• We're Hiring! - Prior Authorization (RCM) Exciting opportunity in the Healthcare RCM industry! We are looking for passionate and detail-oriented professionals to join our Prior Authorization team. * Position: Prior Authorization Executive / Specialist / Account Receivable / EVBV * Department: Revenue Cycle Management (RCM) * Experience: 1-3 years and Freshers * Location: Navi Mumbai * Shift: Fixed Night Shift (US) Key Requirements: / Strong understanding of insurance verification and authorization processes • Experience in interacting with payers and providers Excellent communication and coordination skills Famillarity with US healthcare terminologies Interested candidates can share their resumes at: darshanphule@gmail.com WhatsApp: 9167378546 #hiring #rcm #priorauth #healthcarejobs #revenuecyclemanagement #medicalbilling
Key Responsibilities: Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis. Understand the reason for rejection, denials, or no status from the payer. Work on the resolution of the claim by performing follow-up with the payer using the most optimal method, i.e., calling, IVR, web, or email. Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client and internal teams. Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail. Ensure adherence to Standard Operating Procedures and compliance. Highlight any global trend/pattern and issue escalation with the leadership team. Meet the productivity and quality target on a daily/monthly basis. Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training. Requirements: Candidates with DME experience is good to go. Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution. Fluent communication, both verbal and written. Good analytical skills, attention to detail, and resolution-oriented. Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management. Basic knowledge of computers and MS Office. Preferred Qualities: Eagerness to learn and grow within the finance team. Ability to work both independently and collaboratively. Time management skills and ability to meet deadlines in a fast-paced environment.
Key Responsibilities: Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis. Understand the reason for rejection, denials, or no status from the payer. Work on the resolution of the claim by performing follow-up with the payer using the most optimal method, i.e., calling, IVR, web, or email. Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client and internal teams. Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail. Ensure adherence to Standard Operating Procedures and compliance. Highlight any global trend/pattern and issue escalation with the leadership team. Meet the productivity and quality target on a daily/monthly basis. Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training. Requirements: Candidates with DME experience is good to go. Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution. Fluent communication, both verbal and written. Good analytical skills, attention to detail, and resolution-oriented. Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management. Basic knowledge of computers and MS Office. Preferred Qualities: Eagerness to learn and grow within the finance team. Ability to work both independently and collaboratively. Time management skills and ability to meet deadlines in a fast-paced environment. Show more Show less
As an Accounts Receivables (AR) professional within Revenue Cycle Management (RCM) and Medical Billing in the US Healthcare domain, you will be a valuable asset to RevUpside Business Solutions Pvt Ltd. Located in Vashi, Navi Mumbai, we are a rapidly expanding provider of RCM services to physician groups and hospitals in the United States. With a focus on end-to-end Revenue Cycle Management, including AR resolution for healthcare clients, we are committed to ensuring financial health for providers, allowing them to concentrate on patient care. In this role, your responsibilities will include following up with insurance companies on outstanding claims, analyzing and resolving denied and unpaid claims, working on aging reports for timely recovery, documenting all follow-up activities, meeting productivity and quality targets, and collaborating with internal teams to enhance process efficiency. To excel in this position, you should have at least 4 years of experience in US Healthcare AR calling or Medical Billing with a solid understanding of denial management and revenue cycle workflow. Strong communication skills, familiarity with practice management systems and EHRs, and the ability to thrive in a fast-paced, growth-oriented environment are essential. At RevUpside, we prioritize internal career growth, offering rapid advancement opportunities and a supportive work culture that promotes continuous learning and development. Join our dynamic team at our office in Vashi, Navi Mumbai, and contribute to our success in the healthcare RCM industry. If you are enthusiastic about healthcare revenue cycle management and seek to create a meaningful impact in the industry, we invite you to apply by sending your resume to hr@revupside.com. Take the opportunity to grow with us and be part of our journey towards excellence.,
Responsibilities: Source and screen candidates via portals & social media Coordinate interviews and assist in hiring processes Draft and post job descriptions Maintain candidate databases and recruitment reports Spuport onboarding and HR documentation Requirements: Bachelors in HR or related field. Strong communication & interpersonal skills Organized, proactive, and eager to learn Basic knowledge of recruitment tools & MS Office Show more Show less
Key Responsibilities: Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis. Understand the reason for rejection, denials, or no status from the payer. Work on the resolution of the claim by performing follow-up with the payer using the most optimal method, i.e., calling, IVR, web, or email. Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client and internal teams. Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail. Ensure adherence to Standard Operating Procedures and compliance. Highlight any global trend/pattern and issue escalation with the leadership team. Meet the productivity and quality target on a daily/monthly basis. Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training. Requirements: Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution. Fluent communication, both verbal and written. Good analytical skills, attention to detail, and resolution-oriented. Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management. Basic knowledge of computers and MS Office. Preferred Qualities: Eagerness to learn and grow within the finance team. Ability to work both independently and collaboratively. Time management skills and ability to meet deadlines in a fast-paced environment.
Key Responsibilities: Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis. Understand the reason for rejection, denials, or no status from the payer. Work on the resolution of the claim by performing follow-up with the payer using the most optimal method, i.e., calling, IVR, web, or email. Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client and internal teams. Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail. Ensure adherence to Standard Operating Procedures and compliance. Highlight any global trend/pattern and issue escalation with the leadership team. Meet the productivity and quality target on a daily/monthly basis. Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training. Requirements: Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution. Fluent communication, both verbal and written. Good analytical skills, attention to detail, and resolution-oriented. Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management. Basic knowledge of computers and MS Office. Preferred Qualities: Eagerness to learn and grow within the finance team. Ability to work both independently and collaboratively. Time management skills and ability to meet deadlines in a fast-paced environment.
💡 Key Responsibilities: Manage end-to-end revenue cycle processes including patient registration, insurance verification, billing, coding, charge entry, claims submission, payment posting, and collections. Ensure compliance with healthcare regulations, payer policies, and coding standards (ICD-10, CPT, HCPCS). Identify and resolve denials and rejections in a timely manner. Monitor accounts receivable and follow up on unpaid claims. Work with patients on payment plans and financial counseling. Collaborate with clinical and administrative teams to ensure proper documentation and billing practices. Generate reports on revenue performance, billing trends, and collection rates. Recommend process improvements to increase efficiency and cash flow. ✅ Qualifications: Bachelor's degree in Healthcare Administration, Finance, Business, or related field (preferred). 2+ years of experience in Revenue Cycle Management, medical billing, or healthcare finance. Strong knowledge of medical billing software and EHR systems (e.g. Epic, Cerner, Athena). Familiarity with Medicare, Medicaid, and commercial insurance policies. Excellent analytical, communication, and problem-solving skills. Ability to work independently and handle confidential information with integrity. 💰 Salary & Benefits: Competitive salary based on experience. Paid time off and holidays. Professional development opportunities.
Key Responsibilities for AR: Review account thoroughly, including any prior comments on the account, EOBs / ERAs / Correspondence, and perform pre-resolution analysis. Understand the reason for rejection, denials, or no status from the payer. Work on the resolution of the claim by performing follow-up with the payer using the most optimal method, i.e., calling, IVR, web, or email. Take appropriate action to move the account towards resolution, including rebilling the claim, sending claims for reprocessing, reconsideration, redetermination, appeal (portal/web, fax, mail), verifying eligibility and benefits, and managing management hand-off with the client and internal teams. Documentation of all the actions on the practice management system and workflow management system, and maintain an audit trail. Ensure adherence to Standard Operating Procedures and compliance. Highlight any global trend/pattern and issue escalation with the leadership team. Meet the productivity and quality target on a daily/monthly basis. Upskill by learning new/additional skills and enhancing competencies. Active participation in all process/client-specific training and refresher training. Requirements: Undergraduate / Graduate in any stream with 2 to 4 years of experience in US Healthcare RCM for Account Receivable / Denial Management Resolution. Fluent communication, both verbal and written. Good analytical skills, attention to detail, and resolution-oriented. Should have knowledge about the RCM end-to-end cycle and proficiency in AR fundamentals and denial management. Basic knowledge of computers and MS Office. Key Responsibilities for EVBV: Review and verify patient insurance coverage, eligibility, and benefits prior to appointments or claim submission. Conduct insurance verification through payer websites, IVR systems, or direct calls to insurance companies. Accurately document insurance benefits, co-pays, deductibles, co-insurance, and coverage limitations in the practice management system. Identify discrepancies or inactive policies and escalate or resolve them as appropriate. Maintain up-to-date knowledge of insurance plans, benefit structures, and payer guidelines. Ensure timely and accurate completion of verifications as per client SLA or daily targets. Adhere to Standard Operating Procedures (SOPs) and compliance guidelines. Escalate payer-related issues, trends, or delays to team leads or management. Participate in client-specific training and continuous upskilling programs. Requirements: Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Eligibility & Benefits Verification. Strong communication skills (verbal and written) with clarity and professionalism during payer calls. Proficient in working with payer portals, IVR systems, and MS Office tools. Basic understanding of insurance terminology (e.g., HMO, PPO, deductible, co-pay, out-of-network). Ability to work under deadlines with strong attention to detail and accuracy. Knowledge of the end-to-end RCM process and patient access cycle is preferred. Key Responsibilities for Authorization: Review patient and procedure details to determine if prior authorization is required based on payer policies. Obtain authorizations by submitting complete and accurate information through payer portals, fax, or direct calls. Understand and follow payer-specific authorization guidelines and timelines. Track and follow up on pending authorization requests and escalate issues if needed. Ensure timely documentation of authorization numbers, approval dates, and denial reasons in the practice management system. Communicate with providers, patients, and internal teams regarding authorization status and requirements. Respond to reauthorization requests or additional information required by payers. Maintain compliance with HIPAA and payer-specific regulations. Stay updated with changes in authorization requirements and payer-specific guidelines. Meet daily/weekly targets for authorization submissions and follow-ups. Participate actively in team meetings, training sessions, and process improvements. Requirements: Undergraduate / Graduate in any stream with 1 to 3 years of experience in US Healthcare RCM, specifically in Authorization Management. Experience in submitting and managing authorization requests via insurance portals, fax, or telephonic communication. Sound knowledge of payer-specific requirements for different specialties (e.g., radiology, DME, sleep studies, surgeries, etc.). Excellent communication skills (both verbal and written), especially for handling payer calls. Familiarity with documentation and record-keeping in EHR/EMR or RCM systems. Basic proficiency in MS Office and navigating web-based payer platforms.