Healthcare Revenue Cycle Expert
8 hours ago
Healthcare Revenue Cycle Professional
Join a dynamic team of skilled professionals dedicated to delivering exceptional results in Healthcare Revenue Cycle Management (RCM).
Job Summary:We are seeking experienced professionals to join our growing RCM team. If you have expertise in Medical Coding, Billing, Denial Management, Prior Authorization, Credentialing, Front Office Coordination, or RCM Team Leadership, we invite you to apply.
Key Responsibilities:- Review clinical documentation and assign accurate ICD-10, CPT, and HCPCS codes.
- Ensure coding accuracy adhering to CMS and payer guidelines.
- Collaborate with healthcare providers for documentation clarification.
- Maintain proficiency in EHRs like eClinicalWorks, Epic, Cerner, Athena.
- Submit insurance claims (manual/electronic) and follow up on rejections.
- Post payments and reconcile accounts.
- Verify patient insurance coverage and benefits.
- Handle Medicare, Medicaid, and commercial insurances.
- Analyze EOBs and identify root causes of denials.
- Draft and submit appeals with supporting documentation.
- Maintain denial logs and collaborate with coding and billing teams.
- Submit prior auth requests to insurance companies.
- Track approvals and communicate statuses to healthcare providers/patients.
- Ensure compliance with payer turnaround timelines.
- Submit and track credentialing applications with payers.
- Maintain provider profiles (CAQH, PECOS).
- Coordinate with healthcare providers for documentation and compliance.
- Answer inbound calls from patients and insurance representatives.
- Handle billing queries, coverage explanations, denial statuses, and prior auth information.
- Document interactions in EMR/CRM systems.
- Ensure HIPAA compliance and quality service.
- Lead a team across medical coding, billing, denial management, and credentialing.
- Ensure SLA/KPI adherence, client communication, and team development.
- Monitor quality, manage escalations, and enforce compliance protocols.
- Strong understanding of US healthcare RCM processes.
- Knowledge of ICD-10, CPT, HCPCS, EOBs, CARC/RARC, NPI/PECOS.
- Familiarity with tools like eClinicalWorks, Kareo, Availity, CAQH, AthenaHealth.
- Excellent communication, attention to detail, and time management.
- EMR/EHR and payer portal proficiency.
- Medical Coder/Biller: CPC, CCS, CPB (AAPC/AHIMA).
- Credentialing: CPCS (NAMSS).
- Team Lead: CRCP (HFMA), Lean Six Sigma (Green/Yellow Belt).
- Front Office: Medical Front Office Assistant (optional).
- Strong communication skills.
- 1–5 years depending on the role.
- Specialty coding or multi-specialty billing experience is a plus.
- Prior exposure to US-based clients is advantageous.
- RCM Team Lead: 5–7 years overall, with 2–3 years of supervisory experience.
- Bachelor's or Associate's degree in Life Sciences, Healthcare Administration, or related fields.
- Master's/MBA (Healthcare focus) for leadership roles – preferred.
Join us and contribute to transforming healthcare operations
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