RCM SPECIALIST (USA HEALTHCARE)

Job Summary:
The Medical Billing Associate is responsible for creating and processing accurate medical bills and claim forms (including HCFA/CMS-1500), ensuring compliance with payer requirements and coding standards. The role requires strong knowledge of CPT and ICD-10 codes, attention to detail, and an understanding of healthcare billing workflows to ensure timely and accurate claim submission and reimbursement.Key Responsibilities:

• Prepare and generate accurate medical bills and HCFA (CMS-1500) claim forms based on patient encounters and medical documentation.
• Review and validate patient demographics, provider details, insurance information, and service codes before claim creation.
• Apply correct CPT, ICD-10, and HCPCS codes to ensure claims meet payer requirements.
• Verify claim accuracy and completeness prior to submission to clearinghouses or payers.
• Identify and correct billing errors to minimize claim rejections or denials.
• Coordinate with the coding, charge entry, and AR teams to ensure accurate and timely billing.
• Maintain compliance with HIPAA, CMS, and payer-specific billing regulations.
• Assist in claim resubmissions, adjustments, and appeals when necessary.
• Maintain organized billing records and documentation for audit and reporting purposes.

Qualifications and Requirements:

• Bachelor’s degree in Commerce, Healthcare Administration, or a related field (preferred).
• 1–3 years of experience in U.S. medical billing or revenue cycle operations.
• Proficiency in preparing HCFA/CMS-1500 claim forms and using billing software (e.g., Kareo, AdvancedMD, eClinicalWorks, Athenahealth, or similar).
• Understanding of CPT, ICD-10, and HCPCS coding systems.
• Excellent attention to detail, analytical ability, and organizational skills.
• Good communication and coordination skills for working with cross-functional teams.
• Ability to work independently and meet deadlines in a fast-paced environment.

Job Type: Full-time

Pay: Rs90,000.00 - Rs120,000.00 per month