Senior Revenue Operations Specialist

1 day ago

Hyderabad, Telangana, India beBeeRevenue Full time ₹ 1,08,56,250 - ₹ 2,11,22,500

Revenue Cycle Management (RCM) is a complex and challenging field that requires strong analytical, problem-solving, and communication skills.

The Senior Revenue Analyst will play a key role in handling complex and escalated claims within the US Healthcare RCM process. The team ensures efficient resolution of denied or aged claims, identifies root causes of payment delays, and implements corrective actions to improve revenue recovery.

Key Responsibilities:
  • Investigate and resolve denied, aged, or complex medical claims to maximize reimbursement
  • Identify patterns in claim denials using CARC & RARC combinations, work on root cause analysis, and take corrective actions
  • Perform follow-ups with insurance providers (Payers) to resolve outstanding balances as needed
  • Download, review, share and update teams about payer behavior impact on acute and ambulatory scope of work
  • Billing & coding guideline correlation & impact analysis: Connect dots between coding and billing combinations that must be billed for acute & ambulatory
  • Process Optimization: Identify inefficiencies and suggest workflow improvements to enhance revenue cycle performance
  • Compliance & Documentation: Ensure adherence to industry regulations while maintaining accurate documentation
  • Collaboration: Work closely with Front, Middle & back functions to streamline operational workflows and process flows
  • Training & Knowledge Sharing: Train, coach and mentor team members aligned to by providing meaningful insights and best practices to enhance project performance
  • Root cause analysis: Identify issues hindering resolution of claims by performing process deep dives, RCA's, audits / reviews wherever needed and recommend corrective and preventive actions
  • Financial KPI management: Evaluate & comprehend logic behind KPIs like collection goals, denial %, rejections %, AR days, AR 90+% & provider bad debt (write offs)

This role is crucial for improving cash flow, reducing bad debt, and ensuring financial stability for healthcare providers by optimizing the revenue cycle process.

Requirements:
  • Bachelor's degree in finance, healthcare administration, business, or a related field
  • 3+ years of experience in revenue cycle management, with at least 3+ years in a leadership/mentorship role
  • Experience in AR follow-up, appeals, and dispute resolution
  • Knowledge of HIPAA and payer-specific policies
  • Solid knowledge of US healthcare RCM, insurance claim adjudication, and denial management
  • Proficiency in RCM tools and healthcare billing software
  • Proven analytical, problem-solving, and communication skills
  • Proven ability to maneuver through ambiguity

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