revenue cycle management specialist

Top Line Resource Group (TLRG)

Location: DHA Phase 8, Lahore [Onsite]Employment Type: Full-timeWork Timing: 05PM &ndash; 02AM Pakistan TimeJob OverviewTopline Resource Group (TLRG) is seeking a highly experienced and results-driven Revenue Cycle Management (RCM) Specialist to oversee operations for multiple healthcare clients across different states.The ideal candidate will have extensive experience managing the end-to-end medical billing revenue cycle, including insurance verification, coding review, claims submission, payment posting, accounts receivable follow-ups, and denial management.Key ResponsibilitiesOversee and manage end-to-end Revenue Cycle Management operations for multiple healthcare provider clients.Supervise and support internal RCM teams handling:<ul><li>Insurance Verification (VOBs)</li><li>Prior Authorizations</li><li>Medical Coding Review</li><li>Charge Entry</li><li>Claims Submission</li><li>Payment Posting</li><li>Accounts Receivable (AR) Follow-ups</li><li>Denial Management</li></ul>Monitor claim lifecycle performance, ensuring accurate and timely claim submissions and reimbursements.Analyze EOBs, ERAs, and payer remittance reports to identify trends in denials, underpayments, and claim rejections.Communicate directly with US insurance payers and client representatives to resolve complex billing issues.Ensure compliance with payer policies, CMS regulations, and HIPAA guidelines.Develop and implement process improvements to increase collection rates and reduce AR aging.Track and manage KPIs including AR aging, denial rate, clean claim rate, and reimbursement turnaround time.Provide training, mentorship, and performance management for RCM staff.Coordinate with internal departments including coding, billing, compliance, and client services to ensure seamless revenue cycle operations.Maintain accurate documentation and reporting for client performance metrics and operational updates.Required Qualifications<ul><li>Bachelor&rsquo;s degree in Healthcare Administration, Business, or a related field preferred.</li><li>5+ years of experience in Medical Billing and Revenue Cycle Management.</li><li>Minimum 2 years of experience in a supervisory or team lead role within an RCM environment.</li><li>Strong knowledge of the complete medical billing lifecycle.</li></ul>Expert-level familiarity with:<ul><li>CPT Codes</li><li>ICD-10 Codes</li><li>HCPCS Codes</li><li>Claim submission workflows</li><li>Denial management processes</li></ul>Experience working with multiple payers including Medicare, Medicaid, and Commercial insurance plans.Hands-on experience with EHR/EMR and Practice Management systems.Strong analytical and problem-solving abilities for resolving complex claim and reimbursement issues.Excellent verbal and written English communication skills for interacting with US clients and payers.Ability to manage high-volume workloads while maintaining accuracy and compliance.Preferred SkillsPrior experience managing multiple US healthcare provider accounts across different states.Experience working in US healthcare BPO or medical outsourcing environments.Familiarity with payer-specific billing guidelines and state-based insurance requirements.Strong leadership skills with the ability to build and manage high-performing RCM teams.Experience with performance reporting, operational dashboards, and AR analytics.Knowledge of HIPAA compliance, CMS regulations, and payer audit requirements.Application Question(s):<ul><li>We are looking to hire immediately, are you available to join immediately?</li></ul>Experience:<ul><li>RCM: 4 years (Required)</li></ul>Work Location: In person

Revenue Cycle Management (RCM) Manager

MyOme

<div>
 MyOme&rsquo;s mission is to provide clinically actionable genetic information to patients throughout their lives. We combine clinical-grade whole genome sequencing, advanced AI methods for genome interpretation, and seamless digital tools for doctors and patients to order and access results. Our team is composed of seasoned entrepreneurs, scientists, and operators, and we're backed by top-tier investors.
 
 
 
 Position Overview:
 
 
 
 We are looking for a Billing Specialist to join our Customer Support pod at a pivotal moment in MyOme's growth. You won't be stepping into a fully built billing function &mdash; you'll be shaping it. As the single point of contact for all things billing, you'll own full-cycle revenue cycle management end-to-end, work directly with patients, providers, and internal teams, and build the systems and documentation that prevent issues before they escalate.
 
 
 If you're energized by building playbooks, not following them &mdash; and you want your billing expertise to matter at a company where it will directly impact patient outcomes &mdash; this is the role.
 
 
 
 What You'll Do:Patient-facing billing support:
 
 
 
 
 
 <ul>
 <li>
 Primary point of contact for all patient billing inquiries &mdash; first inquiry to final resolution via phone calls and tickets
 </li>
 <li>
 Educate patients on cost transparency, EOBs, insurance benefits, and financial assistance options in plain, accessible language
 </li>
 <li>
 Handle billing escalations with empathy and urgency
 
 
 </li>
 </ul>
 
 Provider &amp; partner billing support:
 
 
 
 
 
 <ul>
 <li>
 Respond to provider and partner billing questions accurately and promptly
 </li>
 <li>
 Clarify CPT codes, reimbursement policies, and prior authorization requirements
 </li>
 <li>
 Communicate billing updates and policy changes to relevant contacts
 
 
 </li>
 </ul>
 
 Revenue cycle &amp; cross-functional operations:
 
 
 
 
 
 <ul>
 <li>
 Own full-cycle RCM &mdash; claims submission, payment posting, denial management, appeals tracking, and resolution
 </li>
 <li>
 Partner with finance and commercial operations to align billing workflows with organizational goals
 </li>
 <li>
 Identify denial trends and implement SOPs to reduce errors and increase resolution rates
 </li>
 <li>
 Manage escalations between patients, payors, and internal departments
 </li>
 <li>
 Contribute to billing ticket metrics and dashboard reporting
 </li>
 <li>
 Proactively surface ambiguous billing ownership issues before they become blockers
 
 
 </li>
 </ul>
 
 Systems &amp; documentation:
 
 
 
 
 
 <ul>
 <li>
 Own the billing SOP library &mdash; build it, maintain it, and improve it as the company scales
 </li>
 <li>
 Leverage HubSpot and clearinghouse/claims platforms to document interactions and track trends
 </li>
 <li>
 Contribute to AI-assisted deflection workflows for tier-1 billing FAQs
 </li>
 <li>
 Maintain HIPAA compliance; HIPAA/PHI training must be completed within the first 30 days
 
 
 </li>
 </ul>
 
 What You'll Ne
 
 
 ed:
 
 
 
 <ul>
 <li>
 3&ndash;6 years of medical billing and RCM experience &mdash; genomics, clinical laboratory, or precision medicine a significant advantage
 </li>
 <li>
 Deep knowledge of full-cycle RCM: EOBs, CPT/ICD-10 coding, denial management, appeals, prior authorizations, and payer processes
 </li>
 <li>
 Experience working cross-functionally with finance, operations, or clinical teams
 </li>
 <li>
 Familiarity with billing and clearinghouse platforms; HubSpot or equivalent CRM preferred
 </li>
 <li>
 Strong communicator &mdash; equally comfortable explaining a bill to an anxious patient and presenting billing trends to leadership
 </li>
 <li>
 Systems thinker who builds SOPs as a habit, not an exception
 </li>
 <li>
 Comfortable with AI tools and automation &mdash; you see them as a force multiplier, not a threat
 </li>
 <li>
 HIPAA certified or willing to complete certification immediately upon hire
 </li>
 <li>
 Startup or early-stage experience preferred &mdash; you're comfortable building the playbook, not following one
 
 
 </li>
 </ul>
 
 Location, Compensation, and Benefits:
 
 
 
 <ul>
 <li>
 
 Location:
 
 Remote in the US
 </li>
 <li>
 
 Compensation:
 
 Annual base salary range is $70,000 - $90,000, depending on experience and location
 
 
 </li>
 </ul>
 San Francisco Bay Area pay range: $70,000 USD - $90,000 USD
 
 
 
 Benefits:
 
 
 
 <ul>
 <li>
 Comprehensive healthcare coverage (Health, Dental, and Vision)
 </li>
 <li>
 401K
 </li>
 <li>
 Unlimited PTO
 </li>
 <li>
 Professional development opportunities
 </li>
 <li>
 Company-sponsored off-sites and team meals during in-person meetings
 </li>
 <li>
 Direct access to company leadership and the opportunity for career growth
 
 
 </li>
 </ul>
 
 Diversity, Inclusion, and Equal Opportunity:
 
 
 
 MyOme values diversity in all forms. We believe that diverse perspectives drive better science and better patient outcomes. We are an Equal Opportunity Employer committed to creating an inclusive workplace that empowers every individual.
 
 
 
 Why Work at MyOme?
 
 
 
 
 Join us if you:
 
 
 
 <ul>
 <li>
 Want to make an impact at the intersection of healthcare and technology, changing the way people engage with their health at the genetic level
 </li>
 <li>
 Enjoy rolling up your sleeves, taking initiative, and being empowered to lead
 </li>
 <li>
 Value humility, transparency, and collaborative problem-solving
 </li>
 <li>
 Thrive in fast-moving, dynamic environments with smart, driven teammates
 </li>
 <li>
 Appreciate competitive compensation, meaningful equity, and excellent benefits
 
 
 </li>
 </ul>
 Learn More: myome.com
</div>

Billing Specialist

True North LLC

<div>RCM AR Specialist 
True North LLC |
 
Full-Time | Salaried | Exempt
Join a Team Where You Can Grow, Make an Impact, and Build a Career
Are you energetic, detail-oriented, and ready to grow your career in healthcare Revenue Cycle Management? Do you enjoy solving problems, working with data, improving processes, and being part of a team that genuinely supports one another?
At True North, we are looking for a motivated RCM AR Specialist to help drive operational excellence and support healthcare clients through effective Accounts Receivable and billing management. This is an exciting opportunity to join a fast-growing organization where your work directly impacts financial performance, client success, and workflow innovation.
This role is ideal for someone who wants more than a repetitive billing position. We&rsquo;re looking for professionals who are proactive, curious, collaborative, and excited to grow within a company that values culture, teamwork, accountability, and continuous improvement.
Why You&rsquo;ll Love Working at True North
At True North, we believe great people create great results. We&rsquo;ve built a collaborative and positive work environment where employees are encouraged to learn, contribute ideas, and continue developing professionally.
Our team members enjoy:<ul><li>
A supportive, team-oriented culture where people genuinely help one another succeed
</li><li>Opportunities for professional growth and career advancement
</li><li>Leadership that values innovation, accountability, and fresh thinking
</li><li>Meaningful work that directly impacts healthcare operations and client outcomes
</li><li>A fast-paced environment that keeps work engaging and rewarding
</li><li>The ability to make a visible difference and contribute to process improvements
</li></ul>If you&rsquo;re someone who enjoys taking initiative, solving challenges, and being part of a growing organization, you&rsquo;ll fit right in here.
What You&rsquo;ll Do
Drive Revenue Cycle Success<ul><li>
Investigate and resolve billing discrepancies, failed transactions, and short payments
</li><li>Support Accounts Receivable workflows and payment reconciliation processes
</li><li>Help improve billing accuracy and operational efficiency across the revenue cycle
</li></ul>Collaborate Across Teams<ul><li>
Partner with Client Success Managers and internal teams to resolve client billing issues
</li><li>Assist in developing billing resolution plans that align with operational standards and client expectations
</li><li>Communicate effectively with team members to ensure timely issue resolution
</li></ul>Improve Processes &amp; Workflows<ul><li>
Identify opportunities for automation and workflow improvements
</li><li>Analyze billing trends and help support data-driven operational decisions
</li><li>Contribute ideas that improve efficiency, reduce errors, and strengthen financial outcomes
</li></ul>Support Operational Excellence<ul><li>
Work within billing systems and reporting tools to maintain accurate financial records
</li><li>Utilize Excel and data analysis tools to identify trends and support leadership insights
</li><li>Assist with additional RCM and operational projects as needed
</li></ul>What Makes This Role Exciting?
This position offers the opportunity to build valuable experience in healthcare Revenue Cycle Management while working in a collaborative, growth-focused environment. You won&rsquo;t just process transactions &mdash; you&rsquo;ll help solve problems, improve systems, and contribute to the success of both clients and the organization.
As True North continues to grow, team members who demonstrate initiative, reliability, and strong problem-solving abilities will have opportunities to expand their responsibilities and advance professionally. This is a great role for someone looking to grow into a long-term career in healthcare operations, finance, or client success.
Who Will Thrive in This Role?
The ideal candidate is energetic, organized, and eager to learn. They enjoy working with both people and processes while helping improve operational outcomes behind the scenes.
Successful candidates are:<ul><li>
Detail-oriented and analytical
</li><li>Positive, proactive, and solutions-focused
</li><li>Comfortable working in fast-paced environments
</li><li>Strong communicators and collaborative team players
</li><li>Curious about process improvement and operational efficiency
</li><li>Motivated to learn new systems, tools, and technologies
</li><li>Excited about long-term growth opportunities within a growing organization
</li></ul>About True North LLC
True North LLC, a growing organization committed to innovation, operational excellence, and building strong partnerships. We are passionate about creating opportunities for employees to grow professionally while making a meaningful impact on the clients and industries we serve.
If you&rsquo;re looking for a career where you can learn, grow, contribute, and be part of a great culture &mdash; we&rsquo;d love to meet you.
Apply today and help us build stronger healthcare operations together.
Qualifications &amp; Skills<ul><li>
1&ndash;2 years of Revenue Cycle Management or healthcare billing experience preferred
</li><li>Strong Microsoft Excel and data analysis skills
</li><li>Familiarity with denial management and payer reconciliation processes
</li><li>Experience using Google Meet, or other remote collaboration platforms
</li><li>Strong organizational, analytical, and problem-solving abilities
</li><li>Ability to identify process improvement opportunities and contribute to workflow optimization
</li><li>Comfortable working independently while collaborating effectively with cross-functional teams</li></ul></div>

RCM AR Specialist

Curana Health

<div>:
<div>
At Curana Health, we&rsquo;re on a mission to radically improve the health, happiness, and dignity of older adults&mdash;and we&rsquo;re looking for passionate people to help us do it.</div><div></div><div> 
As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities.</div><div></div><div> 
Founded in 2021, we&rsquo;ve grown quickly&mdash;now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for.</div><div></div><div> 
If you&rsquo;re looking to make a meaningful impact on the senior healthcare landscape, you&rsquo;re in the right place&mdash;and we look forward to working with you.</div><div></div><div> 
For more information about our company, visit CuranaHealth.com.</div>
Summary:

We are seeking a detail-oriented and proactive medical billing specialist to support our Revenue Cycle Management team. In this role, you&rsquo;ll play a vital part in ensuring accurate and timely billing and collections processes for our services across a range of payers. This is a great opportunity to join a growing, mission-driven organization making a meaningful difference in senior healthcare.
Essential Duties &amp; Responsibilities:
<ul><li>
Manage accounts receivable (A/R) and follow up with governmental and commercial payers in a timely and professional manner</li><li>
File secondary insurance claims electronically</li><li>
Investigate and appeal denied claims</li><li>
Audit patient accounts to ensure accuracy and completeness</li><li>
Address patient inquiries regarding claims and account balances</li><li>
Update and verify insurance information and patient demographics</li><li>
Meet departmental productivity and quality standards</li><li>
Perform other duties as assigned by supervisor or management</li></ul>
Qualifications:
<ul><li>
High school diploma or equivalent</li><li>
Minimum of 3 years of experience in medical billing or revenue cycle operations</li><li>
Proficiency in Microsoft Outlook, Excel, and Word</li><li>
Working knowledge of healthcare billing practices and claim workflows</li></ul><div></div><div> 
We&rsquo;re thrilled to announce that Curana Health has been named the 147th fastest growing, privately owned company in the nation on Inc. magazine&rsquo;s prestigious Inc. 5000 list. Curana also ranked 16th in the &ldquo;Healthcare &amp; Medical&rdquo; industry category and 21st in Texas.</div><div></div><div> 
This recognition underscores Curana Health&rsquo;s impact in transforming senior housing by supporting operator stability and ensuring seniors receive the high-quality care they deserve.</div></div><div></div>

Ensemble Health Partners

<div>Thank you for considering a career at Ensemble!
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!
O.N.E Purpose:<ul><li>
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.</li><li>
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.</li><li>
Striving for Excellence: Execute at a high level by demonstrating our &ldquo;Best in KLAS&rdquo; Ensemble Difference Principles and consistently delivering outstanding results.</li></ul>
The Opportunity:
CAREER OPPORTUNITY OFFERING:<ul><li>
Bonus Incentives</li><li>
Paid Certifications</li><li>
Tuition Reimbursement</li><li>
Comprehensive Benefits</li><li>
Career Advancement</li><li>
This position pays between $29.70 - $31.80 based on experience</li></ul>
The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns. Under indirect supervision, the Coding Appeals Specialist is responsible for reviewing and writing appeals for inpatient Diagnosis Related Group, (DRG) denials in order to support the assigned DRG and to address the clinical documentation utilized in the decision-making process to support the validity of the assigned codes.
Job Responsibilities:<ul><li>
The appeals professional integrates medical coding principles and objectivity in the performance of coding appeals/denials activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns</li><li>
Participates in client system education to gain the knowledge necessary to appeal client accounts in ensuring that the coding is supported by the patient's clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriate</li><li>
Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to client</li><li>
Assist in education and training for client coding companion as it relates to the outcomes of the coding appeals</li><li>
Meet established productivity standards for coding appeals &amp; coding certification requirement</li><li>
Attends in-house sessions to receive updated coding information and changes in coding and/or regulations</li><li>
Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude</li></ul>
Required Experience:
<ul><li>Previous inpatient facility coding experience, working appeals, denials and edits</li><li>
5 years previous experience in coding, required</li><li>
Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements</li><li>
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.</li><li>
This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.</li></ul>
Minimum Education:<ul><li>
High School Diploma or GED</li></ul>
Required Certification:<ul><li>
Active Coding Certification (i.e. RHIA, RHIT, CCS, CIC, CPC, COC, etc.)</li></ul> 
#LI-HB1
#LI-REMOTE
Join an award-winning company
Five-time winner of &ldquo;Best in KLAS&rdquo; 2020-2022, 2024-2025
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
Energage Top Workplaces USA 2022-2024
Fortune Media Best Workplaces in Healthcare 2024
Monster Top Workplace for Remote Work 2024
Great Place to Work certified 2023-2024<ul><li>
Innovation</li><li>
Work-Life Flexibility</li><li>
Leadership</li><li>
Purpose + Values</li></ul>
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:<ul><li>
Associate Benefits &ndash; We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.</li><li>
Our Culture &ndash; Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
</li><li>Growth &ndash; We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.</li><li>
Recognition &ndash; We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.</li></ul>
Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.
Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role&rsquo;s range.
Employment Disclaimers &ndash; Ensemble</div>

Acute Coding Appeals Specialist

Physicians Revenue Group

Job Type: Full-Time | Onsite Shift Timing: Night Shift (06:00 PM &ndash; 03:00 AM) Weekly Off: Saturday &amp; Sunday Location: LahoreJob OverviewWe are seeking an experienced Authorization Specialist to join our US healthcare operations team. The ideal candidate will have hands-on experience in prior authorization processes within the US healthcare system and a strong understanding of Revenue Cycle Management (RCM). This role requires excellent communication skills, attention to detail, and the ability to independently manage authorization workflows.Key Responsibilities<ul><li>Handle end-to-end prior authorization processes for medical procedures, medications, and services</li><li>Verify patient insurance eligibility, coverage, and benefits</li><li>Submit authorization requests via insurance portals, fax, and outbound calls</li><li>Follow up with insurance companies to ensure timely approvals</li><li>Review and interpret payer guidelines for authorization requirements</li><li>Maintain accurate documentation and authorization records in the system</li><li>Coordinate with billing, coding, and clinical teams to resolve authorization-related issues</li><li>Manage denials related to authorization and initiate re-submissions or appeals when required</li><li>Track and report authorization status using MS Excel or internal systems</li><li>Communicate professionally with insurance representatives and internal stakeholders</li></ul>Eligibility &amp; Requirements<ul><li>Qualification: Bachelor&rsquo;s degree (required)</li><li>Experience: Minimum 1&ndash;3 years of experience in prior authorization / RCM (US Healthcare)</li><li>Strong command of English (spoken &amp; written)</li><li>Hands-on experience with insurance portals and authorization workflows</li><li>Proficiency in MS Excel (tracking, reporting, basic formulas)</li><li>Experience in handling calls with insurance companies</li><li>Must be a permanent resident of Lahore</li><li>Willingness to work night shift (US shift)</li></ul>Skills Required<ul><li>Strong communication and interpersonal skills</li><li>In-depth understanding of prior authorization processes</li><li>Analytical and problem-solving skills</li><li>High attention to detail and accuracy</li><li>Ability to manage workload independently and meet deadlines</li><li>Team-oriented with a professional attitude</li></ul>Why Join Us<ul><li>Fixed night shift with weekends off</li><li>Competitive salary based on experience</li><li>Growth opportunities in US healthcare and RCM</li><li>Structured processes and supportive work environment</li><li>Long-term career progression in medical billing</li></ul>Job Type: Full-timeAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Preferred)</li></ul>Education:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>Authorization Specialist: 2 years (Preferred)</li></ul>Work Location: In person

Authorization Specialist

Unified Women's Healthcare

<div>
 
 Overview
 
 
 
 Unified is a nationwide community of providers, operations specialists and thought leaders who look for the greatest opportunities to impact every woman&rsquo;s health, at every stage of their journeys. We are unparalleled in our scale and ability to adapt to address unmet and underserved needs. Through 815+ clinics, 23 IVF labs, nationwide telehealth capabilities and targeted case management, our 2,700+ independent, affiliated providers deliver comprehensive women&rsquo;s health services and continuously work to implement methods and develop techniques or platforms that improve the healthcare experience. We remain focused on enabling the discovery of new ways for our affiliated providers to deliver the high-quality care experience women deserve, in the ways they most wish to receive it, and collaborate across our community to make our vision a reality.
 
 
 We are action oriented. We strategize, implement and execute &ndash; on behalf of the practices we serve.
 
 
 
 About Our RCM Team
 
 
 
 Are you a specialist in the financial healthcare lifecycle? We are looking for talented professionals to join our Revenue Cycle Management team. By applying to this "Talent Pipeline" requisition, you are expressing interest in multiple current and upcoming roles.
 
 
 
 Choose Your Path
 
 
 
 We are currently sourcing for two primary functional areas. Please indicate your preference in your application:
 
 
 <ul>
 <li>
 Coding Analyst: The Coding Analyst is entrusted with the job of reviewing, auditing and coding provider&rsquo;s documentation for the purpose of reimbursement, training, education and compliance using ICD-10 and CPT codes. The successful applicant will serve as an information resource and guide to our providers, clinical staff, practice managers, members of the Revenue Cycle team and other leadership. This position will be directly involved in analyzing pre-bill claim edits, claim denials and AR management, and working alongside the Revenue Specialists, will review and amend denied claims to ensure accurate coding and adherence to payor policy requirements. The Coding Analyst will assist the Revenue Cycle Manager in proactive audits of medical charts and records for compliance with federal coding regulations and guidelines. This role utilizes knowledge of client systems and procedures to provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. The Coding Analyst reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with billing requirements and compliance standards.
 </li>
 <li>
 Medical Coder: This position provides coding services on the inpatient, outpatient, or physician medical records using ICD-10 coding systems to accurately code and bill medical services. He/she serves as an information resource and guide to providers, clinical staff, practice managers, members of the quality assurance team and other leadership. The Medical Coder will be directly involved in claims denial management, working alongside the Revenue Specialists to review and amend denied claims for accurate coding based on physician documentation. The Medical Coder will assist the Compliance Manager in proactive audits of medical charts and records for compliance with federal coding regulations and guidelines. This role uses knowledge of client systems and procedures to provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. The Medical Coder reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with billing requirements and compliance standards.
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 While each role has specific needs, these coding professionals share:
 
 
 <ul>
 <li>
 Provide second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices
 </li>
 <li>
 Audit medical record documentation to identify under-coded and over-coded services; prepare reports of findings and meet with providers to provide education and training on accurate coding practices and compliance issues
 </li>
 <li>
 Interact with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtain clarification of conflicting, ambiguous, or non-specific documentation through provider queries
 </li>
 <li>
 Submit any issues or trends found within documentation by a physician and /or physician extender to Revenue Cycle Manager and/or practice administrator
 </li>
 <li>
 Interact with Revenue Specialists and practice billing specialists to ensure appropriate and complete follow-up of patient accounts to maximize reimbursement through AR management processes, including corrections and resubmissions as needed
 </li>
 <li>
 Analyze individual payor performances regarding fee schedule reimbursements and trends
 </li>
 <li>
 Research, analyze, and respond to inquiries regarding compliance, payor policies and guidelines, inappropriate coding, denials, and billable services
 </li>
 <li>
 Monitor and distribute communications regarding payor policy changes and updates, in relation to our provider specialties
 </li>
 <li>
 Provide training, guidance and oversight to staff less experienced in coding guidelines
 </li>
 <li>
 Serve as an information resource and guide to clinicians, champion the need to change coding behaviors and serve as subject matter expert
 </li>
 <li>
 Train, instruct, and provide support to medical providers and practice billing specialists as appropriate regarding coding compliance, documentation, and regulatory provisions, and third-party payor requirements
 </li>
 <li>
 Review, develop, modify, and adapt relevant client procedures, protocols, and data management systems to ensure compliance with organization&rsquo;s policies
 </li>
 <li>
 Interact with providers and management to review and/or implement codes and to update charge documents
 </li>
 <li>
 Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws
 </li>
 <li>
 Ensure strict confidentiality of financial and medical record
 </li>
 <li>
 Perform miscellaneous job-related duties as assigned
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Certified Professional Coder (CPC) certification required
 </li>
 <li>
 Minimum of 5 years&rsquo; experience as a biller, collector, coder, or back office support staff, or other equivalent medical industry experience
 </li>
 <li>
 OB/GYN experience preferred, but not required
 </li>
 <li>
 Associates degree from an accredited university preferred
 </li>
 <li>
 Knowledge of auditing concepts and principles
 </li>
 <li>
 Advanced knowledge of medical coding and billing systems and regulatory requirements
 </li>
 <li>
 Ability to use independent judgment and to manage and impart confidential information
 </li>
 <li>
 Ability to analyze and solve problems
 </li>
 <li>
 Ability to travel (up to 25%, as needed)
 </li>
 <li>
 Strong communication and interpersonal skills
 </li>
 <li>
 Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
 </li>
 <li>
 Knowledge of current and developing issues and trends in medical coding procedures requirements
 
 
 </li>
 </ul>
 
 We&rsquo;re here for you&mdash;both personally and professionally.
 
 
 
 Our benefits are designed to support you and your family at every stage of life. From health and wellness to financial security and career growth, we offer a comprehensive package to help you thrive.
 
 
 
 Here&rsquo;s a look at what we offer:
 
 
 
 <ul>
 <li>
 Health Coverage
 
 
 </li>
 </ul>
 Medical, dental, and vision plans, fertility benefits, and supplemental insurance options.
 
 
 <ul>
 <li>
 Paid Time Off
 
 
 </li>
 </ul>
 Vacation, personal days, and paid holidays to help you recharge.
 
 
 <ul>
 <li>
 Financial &amp; Retirement Planning
 
 
 </li>
 </ul>
 401(k) with employer contribution, plus Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs).
 
 
 <ul>
 <li>
 Income Protection
 
 
 </li>
 </ul>
 Short- and long-term disability, paid parental leave, basic life insurance, and optional additional coverage.
 
 
 <ul>
 <li>
 Wellbeing Support
 
 
 </li>
 </ul>
 Employee Assistance Program, commuter benefits, pet insurance, and identity theft protection.
 
 
 <ul>
 <li>
 Professional Development
 
 
 </li>
 </ul>
 Opportunities and resources to support your career growth.
</div>

Medical Claim Coding Talent Pipeline

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