Revenue Cycle Management Specialist

Job Summary: We are seeking an experienced Revenue Cycle Management (RCM) professional with strong expertise in healthcare billing, medical coding, claims management, insurance reimbursements, and patient collections. The individual will be responsible for managing the complete revenue cycle from patient registration and medical coding through insurance claim submission, payment posting, denial management, and final collections.

Key Responsibilities: Manage the end-to-end Revenue Cycle Management (RCM) process. Review and interpret medical records and physician documentation. Assign appropriate medical codes (ICD-10, CPT, HCPCS) based on treatments and procedures. Ensure accurate claim preparation and submission to insurance providers. Follow up with insurance companies regarding claim approvals, denials, and reimbursements. Analyze denied or rejected claims and coordinate corrective actions. Process payment postings from insurance providers and patients. Coordinate with hospitals, clinics, physicians, and payers to resolve billing discrepancies. Monitor Accounts Receivable (AR) and reduce outstanding balances. Ensure compliance with healthcare regulations, payer guidelines, and billing standards. Generate revenue cycle reports and identify opportunities for process improvement.

Required Skills & Experience: 5+ years of experience in Healthcare Revenue Cycle Management. Strong understanding of Medical Coding (ICD-10, CPT, HCPCS).Experience in Claims Processing, Claims Adjudication, Denial Management, and AR Follow-up. Knowledge of US Healthcare System, Insurance Providers, Medicare, Medicaid, and Commercial Payers. Understanding of Patient Billing and Collections. Experience working with Hospital Information Systems (HIS), EHR, EMR, and Billing Platforms. Strong analytical and communication skills. Certification such as CPC, CCS, RHIT, RHIA preferred.