Senior Process Associate RCM (US Healthcare)

Job Title:

Department:

Job Summary:

The Senior Process Associate is responsible for overseeing end-to-end medical billing activities within the US healthcare RCM process. This role involves handling complex billing scenarios, ensuring accurate charge entry, payment posting, denial management, and account follow-up while mentoring junior team members and supporting process improvements to maximize revenue realization and reduce AR days.

Key Responsibilities:

• Review and process medical claims for submission to insurance carriers (primary, secondary, tertiary).
• Ensure accurate

  charge entry, payment posting, and adjustments

  in compliance with payer rules and regulations.
• Perform

  denial analysis and reprocessing

  , identifying root causes to prevent recurrence.
• Handle

  Accounts Receivable (AR) follow-up

  on pending and denied claims to ensure timely reimbursement.
• Verify

  patient demographics, insurance eligibility, and benefits

  before billing.
• Coordinate with payers, providers, and internal teams to resolve billing discrepancies.
• Prepare and analyze

  aging reports

  , identifying trends and recommending corrective actions.
• Maintain compliance with

  HIPAA

  and company policies regarding data security and patient confidentiality.
• Mentor junior billing staff and provide process training as needed.
• Participate in

  quality audits, process improvement initiatives,

  and system updates.

Key Skills & Competencies:

• In-depth knowledge of

  US healthcare RCM process

  (Charge Entry, Payment Posting, AR, Denials, etc.)
• Strong understanding of

  CPT, ICD-10, HCPCS codes

  , and payer-specific billing guidelines.
• Experience working on

  EHR/PM systems

  (e.g., Athena, Kareo, eClinicalWorks, AdvancedMD, etc.)
• Proficient in

  MS Excel

  and reporting tools.
• Excellent analytical, problem-solving, and communication skills.
• Ability to work independently with minimal supervision and handle high-volume billing efficiently.

Qualifications:

• Bachelors degree in any discipline (preferably Life Sciences, Commerce, or Healthcare Management).
• Minimum 4 years of experience in US Healthcare Medical Billing / RCM process.
• Certification in

  Medical Billing and Coding (CPC, CMRS, etc.)

  is a plus.