Senior RCM & Claims Denial Handler

We are looking for a Senior RCM & Claims Denial Handler to join our Reclaim team. The ideal candidate will have strong experience in US healthcare billing, claims, AR follow-up, and denial management. This role requires expertise in identifying the root causes of denials, resolving claim rejections, and implementing corrective actions to maximize revenue recovery.

Key Responsibilities:

• Manage and oversee end-to-end RCM processes including charge entry, payment posting, claims submission, AR follow-up, and denial resolution.
• Analyze denied and rejected claims to identify trends, root causes, and process gaps.
• Handle claim appeals and resubmissions efficiently while ensuring compliance with payer guidelines and timelines.
• Collaborate with payers and insurance representatives to resolve issues promptly.
• Review and interpret EOBs (Explanation of Benefits) and payer responses to ensure accurate posting and reconciliation.
• Monitor aging reports and take proactive steps to reduce AR days.
• Train and mentor junior RCM team members on denial handling processes and best practices.
• Work closely with the coding, billing, and compliance teams to minimize future denials.
• Generate and present performance and denial trend reports to management.
• Ensure adherence to HIPAA and all applicable federal and state regulations.

Required Skills & Qualifications:

• Bachelor’s degree in Healthcare Administration, Business, or related field.
• 5+ years of experience in RCM operations with a strong focus on claims denial management.
• In-depth knowledge of US healthcare billing, CPT, ICD-10, and HCPCS codes.
• Hands-on experience with medical billing software and clearinghouses (e.g., Kareo, Athena, AdvancedMD, eClinicalWorks, or similar).
• Strong analytical, problem-solving, and communication skills.
• Ability to multitask, manage priorities, and meet deadlines in a fast-paced environment.
• High attention to detail with a commitment to accuracy and quality.

Preferred Qualifications:

• Certification in CPB, CPC, or RCM is a plus.
• Prior experience working with US-based healthcare providers or BPO firms.
• Proven track record of improving first-pass claim rates and reducing denial ratios.

Why Join Us:

• Competitive salary and performance-based bonuses.
• Exposure to international clients and advanced healthcare systems.
• Opportunity to lead and mentor a growing team of professionals.
• Supportive environment that values continuous learning and process excellence.

Job Type: Full-time

Pay: Rs15,000.00 - Rs200,000.00 per month

Work Location: In person