RCM Specialist - Quality
This position is posted by Jobgether on behalf of a partner company. We are currently looking for an RCM Specialist - Quality in India.
This role plays a key part in ensuring accuracy, compliance, and efficiency across the revenue cycle management process within the DME/HME healthcare domain. You will be responsible for monitoring and improving billing quality, managing accounts receivable workflows, and supporting end-to-end claims lifecycle activities. The position requires strong attention to detail and a solid understanding of US healthcare payer systems, with a focus on reducing denials and improving reimbursement outcomes. You will collaborate closely with billing, coding, and compliance teams to ensure clean claim submissions and adherence to regulatory standards. In addition, you will contribute to audit processes and quality assurance initiatives that enhance operational performance. The role operates in a fast-paced, process-driven environment where analytical thinking and precision are essential. This is an opportunity to strengthen expertise in healthcare revenue cycle operations while contributing to continuous process improvement.
Accountabilities:
- Manage end-to-end revenue cycle processes for DME/HME services, including billing accuracy, claims submission, and payment posting.
- Perform accounts receivable follow-up and denial management to resolve outstanding claims and reduce AR aging.
- Ensure compliance with US payer guidelines, including Medicare, Medicaid, and commercial insurance requirements.
- Collaborate with billing, coding, and compliance teams to support accurate and compliant claim submissions.
- Monitor industry updates related to coding, billing regulations, and reimbursement policies to ensure operational alignment.
- Support internal and external audit activities by ensuring documentation accuracy and compliance adherence.
- Conduct quality control reviews and recommend process improvements to enhance billing efficiency and accuracy.
Requirements:
- Minimum 2 years of experience in revenue cycle management within the DME/HME healthcare domain.
- Strong hands-on experience in accounts receivable follow-up and denial management processes.
- Good understanding of US healthcare payer systems, including Medicare, Medicaid, and commercial insurance.
- Excellent written and verbal communication skills for effective coordination with internal teams and external stakeholders.
- Strong analytical, problem-solving, and attention-to-detail capabilities.
- Ability to work independently as well as in a team-oriented environment.
- Strong organizational and time management skills with the ability to meet deadlines.
- Familiarity with healthcare billing regulations, coding standards, and reimbursement guidelines.
- Experience with Brightree software is highly preferred.
- Exposure to auditing or quality control processes is an advantage.
- Bachelor's degree is preferred.
Benefits:
- Competitive compensation aligned with healthcare revenue cycle roles
- Opportunity to work in a specialized US healthcare billing environment
- Exposure to end-to-end RCM processes within DME/HME operations
- Career development in healthcare analytics, billing quality, and denial management
- Collaborative and supportive work culture focused on continuous improvement
- Learning opportunities in compliance, audits, and payer regulations
- Inclusive and diverse workplace environment
- Opportunity to contribute to process optimization and operational excellence
