RCM Specialist
5 days ago
Key Responsibilities
- Provide Level 1 and Level 2 support for RCM workflows, including claim
submission, charge entry, payment posting, and denial management.
- Troubleshoot payer rejections, configuration errors, and ERA posting
discrepancies.
- Analyze EDI 835/837 transaction data to identify and resolve logic or
mapping issues.
- Collaborate with clearinghouses (Waystar, Availity, Change Healthcare) to
address payer-related discrepancies.
- Document recurring issues, perform root cause analysis, and work with
internal teams to prevent recurrence.
- Communicate effectively with U.S. clients, ensuring clear, solution-oriented
updates and documentation.
- Maintain compliance with HIPAA and 42 CFR Part 2 guidelines while
handling sensitive data.
Required Skills s Domain Expertise
- Strong understanding of U.S. Healthcare RCM including charge entry,
payment posting, denial analysis, and AR follow-up.
- In-depth knowledge of payer rules (Medicare, Medicaid, commercial
payers).
- Working knowledge of CPT, ICD-10, HCPCS, modifiers, and ERA/EDI 835-
837 transactions.
- Demonstrated ability to identify root causes behind denials and system-level
billing issues.
Technical Competencies
- Hands-on experience with one or more medical billing systems:
Collaborate MD, Kareo, AdvancedMD, Athenahealth, eClinicalWorks,
DrChrono, NextGen, PracticeSuite, or similar.
- Experience using clearinghouse portals such as Waystar, Availity, and
Change Healthcare.
- Familiarity with ticketing tools like Zendesk, Freshdesk, or Salesforce
Service Cloud.
- Strong Excel skills for reporting, validation, and analysis (pivot tables,
lookups).
Customer Support Competencies
- Analytical thinker who investigates workflow issues instead of surface-level
resolutions.
- Excellent written and verbal communication skills tailored for non-technical
audiences.
- Ability to collaborate with internal product or development teams for
technical fixes and process improvements.
- Proven record of maintaining high CSAT scores and quick response times.
Qualifications
- Bachelor's Degree (preferably in Commerce, Healthcare Administration, or
related field).
3–6 years of relevant experience in U.S. Healthcare RCM.
Certifications preferred: HIPAA Awareness, AAPC CPC (in progress or
completed).
Job Type: Full-time
Pay: ₹50, ₹65,000.00 per month
Application Question(s):
- What is your current CTC?
- What is your expected CTC?
- What is your notice period?
- Are you comfortable with rotational shifts and rotational weekoff(Including Night shifts)?
- Are you comfortable with face to face interview in navi mumbai?
Experience:
- US Healthcare RCM: 3 years (Preferred)
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