Certified RCM Consultant

Position Overview:

We are seeking an experienced and certified RCM Consultant to join our team. The ideal candidate will have in-depth knowledge of the US healthcare system, revenue cycle management processes, and medical billing practices. This role requires a professional with proven expertise in managing end-to-end RCM operations, ensuring compliance, and optimizing reimbursement cycles.

Key Responsibilities:

• Oversee and manage end-to-end RCM processes including charge entry, claim submission, payment posting, denial management, and AR follow-up.
• Ensure compliance with US healthcare billing regulations and payer-specific requirements.
• Analyze denial trends, recommend corrective actions, and implement process improvements .
• Collaborate with clients, physicians, and insurance companies to resolve claim issues and maximize reimbursements.
• Maintain accurate documentation and reporting of billing activities.
• Provide expert consultation on RCM strategies and process optimization.
• Train and mentor junior billing staff as needed.
• Stay updated on industry standards, regulations, and coding changes (ICD, CPT, HCPCS).

Requirements:

• Mandatory certification in one of the following:
• CPB® (Certified Professional Biller – AAPC)
• CMRS® (Certified Medical Reimbursement Specialist – AMBA)
• CBCS® (Certified Billing & Coding Specialist – NHA)
• Minimum 3 years of proven experience in US medical billing / RCM.
• Strong knowledge of billing software, clearinghouses, and EHR systems .
• Excellent understanding of insurance guidelines (Medicare, Medicaid, commercial payers).
• Strong analytical, problem-solving, and communication skills .
• Ability to work independently and within a team.