Complete RCM services Specialist

Job Summary:

The RCM Services Specialist is responsible for managing the end-to-end revenue cycle process, including patient registration, insurance verification, charge entry, claims submission, payment posting, denial management, and accounts receivable follow-up. This role ensures that all revenue cycle processes are conducted accurately, efficiently, and in compliance with payer guidelines and healthcare regulations.

Key Responsibilities:1. Front-End RCM

• Perform patient registration and verify demographics and insurance details.
• Ensure accurate and timely insurance eligibility and benefit verification.
• Obtain prior authorizations and pre-certifications when required.
• Educate patients on insurance coverage, copays, deductibles, and financial responsibility.

2. Mid-Cycle RCM

• Review clinical documentation and ensure proper charge capture.
• Enter and audit charges for accuracy and completeness.
• Ensure compliance with CPT, ICD-10, and HCPCS coding standards.
• Collaborate with clinical staff and coders to resolve discrepancies.

3. Back-End RCM

• Submit clean claims electronically or via paper, ensuring payer-specific requirements are met.
• Monitor claim rejections and denials; correct and resubmit in a timely manner.
• Post payments from insurance companies and patients; reconcile with Explanation of Benefits (EOBs).
• Manage accounts receivable (A/R) and perform timely follow-ups on unpaid or underpaid claims.
• Handle patient billing inquiries and collections professionally and sensitively.

Qualifications:

• Bachelor’s degree in healthcare administration, business, or related field preferred.
• High school diploma or GED required.
• Certification in medical billing/coding (e.g., CPC, CCS, CPB) is a plus.
• Minimum 2–4 years of experience in healthcare revenue cycle operations.
• Experience with RCM tools, billing systems (e.g., Epic, Cerner, Kareo, Athenahealth), and clearinghouses.
• Familiarity with Medicare, Medicaid, and commercial insurance payers.

Skills and Competencies:

• Technical Skills: Proficiency in MS Office Suite and EHR/PM systems.
• Knowledge Base: Strong understanding of medical terminology, coding (CPT, ICD-10), and payer guidelines.
• Analytical Skills: Ability to identify claim issues, analyze denial trends, and resolve billing problems.
• Communication: Strong verbal and written communication skills.
• Detail-Oriented: High attention to detail and accuracy in data entry and documentation.
• Time Management: Ability to prioritize tasks and meet deadlines in a fast-paced environment.
• Team Collaboration: Works well in a team environment and collaborates across departments.

Preferred Experience:

• Previous work in a multi-specialty practice, hospital, or billing service provider.
• Experience with value-based care metrics and risk-adjusted coding.
• Familiarity with HIPAA compliance and regulatory standards.

Work Environment & Physical Requirements:

• May require prolonged sitting, extensive use of a computer, and telephone.
• [Specify if remote work is allowed or if travel is required.]

Performance Metrics:

• Claims first-pass rate
• Denial rate and resolution time
• Days in A/R
• Collection rate
• Patient satisfaction scores (for billing inquiries)

Job Type: Full-time

Pay: Rs80,000.00 - Rs150,000.00 per month

Work Location: In person