Reimbursement Specialist

3 weeks ago

Bengaluru, India Total RCM Solutions Full time

Company Overview:

Total RCM Solutions, LLC, established in June 2018, is a prominent revenue cycle management company catering to healthcare providers across the United States. With over 100 years of combined expertise, our team excels in applying tailored processes and workflows to optimize practice success. We offer comprehensive end-to-end RCM services, including claims review, appeal management, and patient service solutions, ensuring excellence in adherence to coding and payor guidelines.


Job Overview:

We are seeking a Junior Reimbursement Specialist for a full-time, remote position based in Bangalore. The role involves comprehensive reimbursements management, focusing on accounts receivable follow-up, insurance denials, and claims resolution, contributing directly to our operational excellence. This is an opportunity to join a dynamic medical billing industry leader with a focus on healthcare RCM services.


Qualifications and Skills:

  • Experience in accounts receivable follow-up, critical for ensuring timely payments and reducing outstanding dues (Mandatory skill).
  • Strong understanding of insurance denials, necessary for resolving payment denials efficiently (Mandatory skill).
  • Proficiency in claims resolution to ensure accurate and timely adjudication process (Mandatory skill).
  • Familiarity with medical billing processes, vital for handling billing requirements and submissions.
  • Expertise in revenue cycle management, which aids in streamlining healthcare financial operations.
  • Ability to process clearinghouse rejections and resubmit claims for prompt financial recovery.
  • Excellent communication skills to effectively liaise with insurance companies and healthcare providers.
  • Analytical skills to identify trends in claim denials and implement strategies for reduction.


Roles and Responsibilities:

  • Manage accounts receivable follow-ups to ensure all claims are processed, paid, and posted accurately.
  • Analyze and resolve insurance denials by communicating with insurance representatives and resubmitting claims as necessary.
  • Perform meticulous claims resolution to improve the cash flow of healthcare providers.
  • Collaborate with healthcare providers and billing teams to address billing issues and improve RCM processes.
  • Engage in thorough documentation of claim status, denials, and resolutions taken for record-keeping and future reference.
  • Provide support and effective communication with patients to resolve their billing inquiries and concerns.
  • Stay updated with industry changes and best practices to ensure compliance with billing and coding requirements.
  • Contribute to team discussions and provide insights for process improvements and training initiatives.

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