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Description
Job Description Subject Matter Expert (SME) Accounts Receivable (AR) (US Healthcare) Job Summary: The Subject Matter Expert (SME) AR is responsible for overseeing the end-to-end accounts receivable (AR) process in US healthcare revenue cycle management (RCM) . This role involves handling complex claims, resolving denials, optimizing collections, and ensuring compliance with industry regulations. The SME will also provide training and guidance to the AR team, ensuring efficient cash flow management and improved revenue recovery. Key Responsibilities: 1. Claims & AR Management Oversee and manage the entire AR process from claim submission to final resolution. Monitor aging reports and follow up on outstanding claims with insurance payers. Work on denied, underpaid, and unpaid claims , identifying root causes and resolution strategies. 2. Denial & Appeals Management Analyze denied claims , determine appropriate appeal strategies, and resubmit claims with supporting documentation. Communicate with insurance companies (Medicare, Medicaid, Commercial Payers, etc.) to resolve claim discrepancies. Maintain a database of denial trends and provide proactive solutions to minimize future denials. 3. Compliance & Documentation Ensure adherence to HIPAA regulations, payer guidelines, and medical coding standards . Stay updated with changes in insurance policies, billing rules, and compliance requirements . Maintain accurate records of claim actions , communications, and resolutions. 4. Process Optimization & Performance Improvement Identify bottlenecks in the AR process and recommend improvements to enhance collections. Collaborate with billing teams to reduce claim rejection rates and improve first-pass claim acceptance . Implement automation tools and best practices to improve operational efficiency. 5. Training & Mentorship Train and mentor AR executives, billing specialists, and junior staff on best practices. Conduct knowledge-sharing sessions on payer trends, denial prevention, and claim adjudication. Act as a liaison between the AR team, clients, and senior management for issue resolution. Required Skills & Qualifications: Experience: 4+ years in US healthcare AR, medical billing, or revenue cycle management (RCM) . Expertise in AR & Denial Management: Strong knowledge of insurance claims processing, EOBs, denials, and appeals . Analytical & Problem-Solving Skills: Ability to analyze denials, rejections, and payer trends to implement corrective actions. Preferred Qualifications: Any Graduation Work Environment & Benefits: Work Mode: Office. Shift Timing: US Shifts - 6:30 TO 3:30 Benefits: Competitive salary, health insurance, performance-based incentives, and professional development opportunities. Interested candidates please do reach out Sughanya V Contact : 7200458446 Mail Id: sughanyav@prochant.com
