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rcm specialist

Vista Consultancy Services VCS Private Limited

Location: Lahore (Remote) Shift Timing: 6:00 PM &ndash; 3:00 AM (Pakistan Standard Time) Employment Type: Full-timeKey Responsibilities<ul><li>Perform Verification of Benefits (VOBs) to confirm insurance eligibility and coverage.</li><li>Accurately manage payment posting for payers and patients.</li><li>Handle Accounts Receivable (AR) by following up on outstanding claims and reducing aging.</li><li>Manage denials and rejections, identify root causes, and ensure timely resolution.</li><li>Prepare and submit appeals with supporting documentation and follow up as needed.</li><li>Process billing for Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) services.</li><li>Collaborate with providers, internal teams, and insurance companies to ensure smooth claim processing.</li><li>Maintain accurate and up-to-date records in RCM systems.</li><li>Use tools such as Tebra, 8x8, Trizetto, and others to enhance workflow efficiency.</li></ul>Required Skills &amp; Qualifications<ul><li>3&ndash;5 years of experience in medical billing or RCM operations.</li><li>Strong understanding of insurance workflows (VOBs, AR, denials, appeals).</li><li>Familiarity with RPM and CCM billing guidelines.</li><li>Basic proficiency in MS Excel (sorting, filtering, formulas).</li><li>Hands-on experience with platforms such as Tebra, Trizetto, and 8x8.</li></ul>Preferred Qualifications<ul><li>Experience with Electronic Health Record (EHR) systems.</li><li>Knowledge of HIPAA compliance and medical billing standards.</li><li>Certification in medical billing or coding (CPC, CPB) is a plus.</li></ul>Job Type: Full-timeWork Location: Remote

RCM Specialist

Jawa Health Care

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<ul><li>Perform patient registration and verify demographics and insurance details.</li><li>Ensure accurate and timely insurance eligibility and benefit verification.</li><li>Obtain prior authorizations and pre-certifications when required.</li><li>Educate patients on insurance coverage, copays, deductibles, and financial responsibility.</li></ul>2. Mid-Cycle RCM<ul><li>Review clinical documentation and ensure proper charge capture.</li><li>Enter and audit charges for accuracy and completeness.</li><li>Ensure compliance with CPT, ICD-10, and HCPCS coding standards.</li><li>Collaborate with clinical staff and coders to resolve discrepancies.</li></ul>3. Back-End RCM<ul><li>Submit clean claims electronically or via paper, ensuring payer-specific requirements are met.</li><li>Monitor claim rejections and denials; correct and resubmit in a timely manner.</li><li>Post payments from insurance companies and patients; reconcile with Explanation of Benefits (EOBs).</li><li>Manage accounts receivable (A/R) and perform timely follow-ups on unpaid or underpaid claims.</li><li>Handle patient billing inquiries and collections professionally and sensitively.</li></ul>Qualifications:<ul><li>Bachelor&rsquo;s degree in healthcare administration, business, or related field preferred.</li><li>High school diploma or GED required.</li><li>Certification in medical billing/coding (e.g., CPC, CCS, CPB) is a plus.</li><li>Minimum 2&ndash;4 years of experience in healthcare revenue cycle operations.</li><li>Experience with RCM tools, billing systems (e.g., Epic, Cerner, Kareo, Athenahealth), and clearinghouses.</li><li>Familiarity with Medicare, Medicaid, and commercial insurance payers.</li></ul>Skills and Competencies:<ul><li>Technical Skills: Proficiency in MS Office Suite and EHR/PM systems.</li><li>Knowledge Base: Strong understanding of medical terminology, coding (CPT, ICD-10), and payer guidelines.</li><li>Analytical Skills: Ability to identify claim issues, analyze denial trends, and resolve billing problems.</li><li>Communication: Strong verbal and written communication skills.</li><li>Detail-Oriented: High attention to detail and accuracy in data entry and documentation.</li><li>Time Management: Ability to prioritize tasks and meet deadlines in a fast-paced environment.</li><li>Team Collaboration: Works well in a team environment and collaborates across departments.</li></ul>Preferred Experience:<ul><li>Previous work in a multi-specialty practice, hospital, or billing service provider.</li><li>Experience with value-based care metrics and risk-adjusted coding.</li><li>Familiarity with HIPAA compliance and regulatory standards.</li></ul>Work Environment &amp; Physical Requirements:<ul><li>May require prolonged sitting, extensive use of a computer, and telephone.</li><li>[Specify if remote work is allowed or if travel is required.]</li></ul>Performance Metrics:<ul><li>Claims first-pass rate</li><li>Denial rate and resolution time</li><li>Days in A/R</li><li>Collection rate</li><li>Patient satisfaction scores (for billing inquiries)</li></ul>Job Type: Full-timePay: Rs80,000.00 - Rs150,000.00 per monthWork Location: In person

Complete RCM services Specialist

Physicians Revenue Group

Location: College Road, Lahore (Onsite) Shift: 06:00 PM &ndash; 03:00 AM PKT (US Time Zone)Company: Physcian Revenue Group Pakistan.Position: Revenue Cycle Management Specialist - Medical Billing - AR SpecialistAbout Us: Physician Revenue Group (PRG) is a leading US-based Revenue Cycle Management (RCM) company with offices in the United States and Pakistan. We provide end-to-end medical billing services to healthcare providers including physicians, clinics, and hospitals, ensuring accurate claims, faster reimbursements, and compliance with US healthcare regulations.Role Overview: We are looking for RCM Billing Executives to manage the end-to-end medical billing cycle for US healthcare providers. The role involves patient eligibility checks, claim creation &amp; submission, payment posting, denial management, AR follow-ups, and reporting. Candidates with strong knowledge of US healthcare billing, insurance guidelines, and RCM processes are encouraged to apply.Key Responsibilities:<ul><li>Manage the full Revenue Cycle Management (RCM) process</li><li>Patient Scheduling &amp; Eligibility Verification</li><li>Claim Creation, Charge Entry &amp; Submission (CMS-1500, UB-04)</li><li>Payment Posting, ERA &amp; EOB reconciliation</li><li>Denial Management &amp; Resubmission of claims</li><li>AR follow-ups with insurance companies &amp; patients</li><li>Patient Statements &amp; Reporting</li><li>Ensure compliance with HIPAA regulations and US healthcare billing standards.</li><li>Work with providers, payers, and patients to resolve billing issues.</li><li>Handle authorizations, referrals, and ABNs where required.</li><li>Apply correct CPT/ICD coding, POS codes, and Modifiers for accurate billing.</li></ul>Use medical billing software such as eCW, AdvancedMD, Tebra, NextGen, Epic, CareCloud, Practice Fusion, Office Ally.Required Skills &amp; Knowledge <ul><li>Strong understanding of US healthcare RCM: Scheduling, Eligibility, Claim Submission, Payment Posting, Denials, AR, Patient Billing, Reporting.</li><li>Knowledge of Medicare, Medicaid, Tricare, Commercial Insurances, Participating vs Non-Participating Providers, Capitation Models, and Authorization Types.</li><li>Familiarity with Modifiers, POS Codes, Common Abbreviations (NPI, TIN, HIPAA, CPT, ICD, EOB, ERA, etc.).</li><li>Exposure to multiple specialties such as Internal Medicine, Family Practice, Pediatrics, Cardiology, Orthopedics, Dermatology, OB/GYN, Psychiatry, Radiology, Neurology, Pulmonology, Endocrinology, and more. (Preferred)</li><li>Good English communication skills (verbal &amp; written).</li><li>Ability to work under deadlines in a fast-paced environment.</li></ul>Qualifications:<ul><li>Bachelor&rsquo;s degree (minimum requirement).</li><li>6 month &ndash; 2 years&rsquo; experience in US-based Medical Billing / RCM.</li></ul>Perks &amp; Benefits <ul><li>Competitive salary + Fuel Card / Allowances.</li><li>Career growth in the US healthcare billing industry.</li><li>Collaborative &amp; supportive work environment.</li><li>Health Insurance</li></ul>If you are passionate about building your career in Medical Billing (RCM) and want to work with a global team, we&rsquo;d love to hear from you.Job Type: Full-timeExperience:<ul><li>Denial Management: 1 year (Preferred)</li></ul>Work Location: In person

RCM - Billing Executive

HRMD Solutions

Location: Gulberg 3, Lahore Shift: Night (Full-time, On-site Only) Salary: Rs. 70,000 &ndash; Rs. 100,000/monthIMPORTANT: Please read before applying&#9989; ONLY candidates with prior experience in Prior Authorization or Medical Billing will be considered.&#10060; Applicants without relevant healthcare experience (e.g., teaching, engineering, IT, sales, etc.) will be automatically rejected.About the Role:We are urgently hiring a Prior Authorization Specialist to join our growing medical billing team focused on pain management. The ideal candidate must have hands-on experience in obtaining insurance authorizations for medical procedures and medications.Key Responsibilities:<ul><li>Obtain and manage prior authorizations for pain management treatments (injections, surgeries, etc.)</li><li>Review and validate patient records to ensure accurate and complete documentation</li><li>Coordinate with insurance companies, providers, and patients to facilitate approvals</li><li>Handle appeals for denied authorizations when necessary</li><li>Track authorization status and follow up regularly to avoid delays</li><li>Collaborate with the clinical team to meet billing and documentation standards</li></ul>Requirements:<ul><li>Minimum 6 months of relevant experience in Prior Authorization or Medical Billing</li><li>Knowledge of pain management treatments is a plus</li><li>Strong understanding of medical coding, terminology, and insurance guidelines</li><li>Familiarity with EHR systems and RCM processes</li><li>Excellent communication and follow-up skills</li></ul>Job Type: Full-timePay: Rs70,000.00 - Rs100,000.00 per monthApplication Question(s):<ul><li>Do you live in lahore?</li><li>Can you work night shift (on site)?</li></ul>Work Location: In person

Prior Authorization Specialist – Medical Billing (Night Shift | On-site Only)

ebs ameri

We Are Hiring Experienced Sales Executives!We are looking for experienced professionals who are passionate about sales and eager to grow in the U.S. healthcare B2B industry. To qualify, you must have at least 2 years of proven sales experience OR a strong track record of exceptional sales performance and revenue generation.In this role, you&rsquo;ll connect with clinics, medical practices, and healthcare businesses across the U.S. to promote our services such as Medical Billing and Revenue Cycle Management (RCM).Key Responsibilities:<ul><li>Engage with U.S.-based healthcare providers (B2B) through cold calls and emails.</li><li>Promote and sell medical billing and healthcare outsourcing services.</li><li>Identify client needs, generate leads, and close deals.</li><li>Maintain long-term business relationships with clients.</li><li>Meet and exceed monthly sales targets.</li><li>Record interactions and progress in CRM tools.</li></ul>What We&rsquo;re Looking For:<ul><li>Minimum 2 years of sales experience OR proven exceptional achievements in sales/revenue generation.</li><li>Passionate about sales and business development.</li><li>Strong English communication and negotiation skills.</li><li>Prior experience in U.S. campaigns or B2B sales is highly preferred.</li><li>Ability to understand and communicate service-based solutions.</li><li>Comfortable working night shift (6:00 PM &ndash; 3:00 AM).</li><li>Goal-oriented, confident, and a self-starter.</li></ul>Job Type: Full-timePay: Up to Rs150,000.00 per monthApplication Question(s):<ul><li>How many years of experience do you have in B2B sales?</li><li>Have you worked in U.S. healthcare sales, medical billing, or RCM before?</li><li>What was your average monthly sales target, and how much revenue did you generate in your previous role?</li></ul>Language:<ul><li>English (Required)</li></ul>Location:<ul><li>Lahore (Required)</li></ul>Work Location: In person

Sales Representative |Medical Billing & RCM

Here&rsquo;s Credentialing Job TitleCredentialing Specialist &mdash; Medical Billing / Provider EnrollmentPosition SummaryThe Credentialing Specialist is responsible for managing the full lifecycle of provider credentialing and enrollment with payers (commercial, Medicare, Medicaid, third&#8209;party networks) to ensure that providers are properly authorized to bill and receive reimbursement. This role liaises between providers, payers, billing teams, and internal departments to maintain compliance, minimize credentialing delays, and support revenue integrity.Key Responsibilities / Duties<ul><li>Provider Credentialing &amp; Enrollment</li><li>Prepare, compile, and submit initial credentialing applications to payers, Medicare/Medicaid, IPAs, health networks.</li><li>Manage re&#8209;credentialing and renewals of existing provider credentials.</li><li>Maintain and update provider profiles (e.g. CAQH, NPPES, PECOS, payer portals).</li><li>Obtain and track provider identifiers (Provider IDs, NPI, Tax IDs, etc.).</li><li>Coordinate with providers (physicians, DME, therapists, clinics) to gather required documentation (licenses, board certifications, CVs, malpractice insurance, etc.).</li><li>Follow up on application status, resolve discrepancies, and expedite submissions.</li><li>Verification &amp; Compliance</li><li>Perform primary source verification (PSV) of credentials (licensure boards, education, certifications).</li><li>Audit credentialing files to ensure completeness, accuracy, and consistency.</li><li>Monitor credential expiration dates (licenses, DEA, certifications) and trigger renewals proactively.</li><li>Ensure compliance with payer, state, and regulatory credentialing requirements, including policy changes and updates.</li><li>Data &amp; Documentation Management</li><li>Maintain credentialing databases, logs, tracking systems, and reports on status metrics (turnaround time, backlog, approval rates).</li><li>Document interactions with payers and providers, maintain records of submissions, denials, and appeals.</li><li>Generate periodic credentialing status reports for management and internal stakeholders.</li><li>Stakeholder Communication &amp; Issue Resolution</li><li>Communicate with payers and insurance networks to resolve credentialing issues, contract queries, missing documentation, and provider disputes.</li><li>Liaise with billing, contracting, HR, compliance, legal, and provider offices for credentialing&#8209;related matters.</li><li>Support billing teams in credential&#8209;related denials or rejections (for example, provider not enrolled).</li><li>Process Improvement &amp; Quality Assurance</li><li>Identify credentialing process bottlenecks and suggest workflow improvements.</li><li>Participate in audits, quality checks, and compliance reviews.</li><li>Stay current on industry trends, payer credentialing rules, regulatory changes, and best practices in provider enrollment.</li></ul>Qualifications &amp; Requirements<ul><li>Education: Bachelor&rsquo;s degree preferred (Healthcare Administration, Business, Health Information Management, or related field). Some organizations accept equivalent experience.</li><li>Experience: 2+ years of experience in provider credentialing, enrollment, or similar role (in a medical billing, RCM, or healthcare setting).</li><li>Knowledge / Technical Skills:</li><li>Familiarity with CAQH, NPPES, PECOS, payer portals, credentialing software/platforms.</li><li>Understanding of commercial &amp; government payers (Medicare, Medicaid) credentialing rules.</li><li>Strong knowledge of medical licensure, board certification, education verification, regulatory compliance.</li><li>Proficiency in MS Office (Excel, Word, Outlook).</li><li>Skills / Competencies:</li><li>Strong attention to detail, organizational skills, and ability to manage multiple credentialing tracks simultaneously.</li><li>Excellent written and verbal communication skills.</li><li>Analytical and problem-solving mindset.</li><li>Ability to work independently and interface with multiple stakeholders.</li><li>Discretion and confidentiality in handling provider data.</li><li>Desired / Optional:</li><li>Certification such as CPCS (Certified Provider Credentialing Specialist) or CPMSM.</li><li>Experience with multi&#8209;state credentialing or large group practices.</li><li>Experience with medical billing, claims, or revenue cycle functions.</li><li>Knowledge of HIPAA or healthcare compliance standards.</li></ul>Working Conditions / Schedule<ul><li>This role is generally in office or hybrid/remote (depending on the organization).</li><li>May require working non&#8209;standard shifts (e.g. night shift) if supporting international clients or off&#8209;hours payer windows.</li><li>Keyboard / computer work, calls, email communications.</li><li>Occasional high volume / urgency periods requiring extra effort to meet credentialing deadlines.</li></ul>Key Performance Indicators (KPIs)<ul><li>Turnaround time for credentialing submissions / approvals</li><li>Percentage of credentialing applications approved without rework</li><li>Number of credentialing backlog / pending items</li><li>Accuracy rate (errors in credentialing files)</li><li>Provider uptime (minimizing provider downtime due to credentialing issues)</li></ul>Job Type: Full-timePay: Rs50,000.00 - Rs80,000.00 per monthWork Location: In person

Experienced Credentialing Specialist in medical billing

Macrise Tech Solutions

Medical Billing<ul><li>Prepare and submit accurate insurance claims and patient invoices in a timely manner.</li><li>Review all claims to ensure completeness, coding accuracy, and compliance with payer requirements.</li><li>Maintain organized billing documentation and up-to-date records in the practice management system.</li><li>Accurately process adjustments, credit memos, and payment postings.</li><li>Regularly update and verify patient demographics and insurance information.</li><li>Generate monthly billing statements and customized Revenue Cycle Management (RCM) reports.</li><li>Support the accounting team with reconciliations and month-end financial reporting.</li><li>Recommend process improvements to streamline billing operations and enhance efficiency.</li></ul>Collections<ul><li>Proactively follow up on unpaid insurance claims and patient balances to secure timely payments.</li><li>Monitor and manage A/R aging reports, prioritizing overdue accounts for resolution.</li><li>Communicate with insurance payers to resolve delays, denials, and underpayments.</li><li>Address patient billing concerns professionally and establish payment arrangements when necessary.</li><li>Partner with billing and patient services teams to resolve complex collection cases.</li><li>Accurately document all collection activities, follow-ups, and communications in the system.</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs80,000.00 per monthAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Preferred)</li></ul>Application Question(s):<ul><li>Willing to work the night shift?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>Work Location: In person

Medical Billing & Collections Specialist

Explore 177+ Rcm specialist in Lahore this October. Find roles across top companies and apply now to boost your career.