Job Description

Key Responsibilities

Provide Level 1 and Level 2 support for RCM workflows, including claim submission, charge entry, payment posting, and denial management. Troubleshoot payer rejections, configuration errors, and ERA posting discrepancies. Analyze EDI 835/837 transaction data to identify and resolve logic or mapping issues. Collaborate with clearinghouses (Waystar, Availity, Change Healthcare) to address payer-related discrepancies. Document recurring issues, perform root cause analysis, and work with internal teams to prevent recurrence. Communicate effectively with U.S. clients, ensuring clear, solution-oriented updates and documentation. Maintain compliance with HIPAA and 42 CFR Part 2 guidelines while handling sensitive data.

Required Skills s Domain Expertise

Strong understanding of U.S. Healthcare RCM including charge entry, payment posting, denial analysis, and AR follow-up. In-depth knowledge of payer rules (Medicare, Medicaid, commercial payers). Working knowledge of CPT, ICD-10, HCPCS, modifiers, and ERA/EDI 835-837 transactions. Demonstrated ability to identify root causes behind denials and system-level billing issues.

Technical Competencies

Hands-on experience with one or more medical billing systems: CollaborateMD, Kareo, AdvancedMD, Athenahealth, eClinicalWorks, DrChrono, NextGen, PracticeSuite, or similar. Experience using clearinghouse portals such as Waystar, Availity, and Change Healthcare. Familiarity with ticketing tools like Zendesk, Freshdesk, or Salesforce Service Cloud. Strong Excel skills for reporting, validation, and analysis (pivot tables, lookups).

Qualifications

Bachelor's Degree (preferably in Commerce, Healthcare Administration, or related field). 3-6 years of relevant experience in U.S. Healthcare RCM. Certifications preferred: HIPAA Awareness, AAPC CPC (in progress or completed).
Job Types: Full-time, Permanent

Pay: ₹200,000.00 - ₹800,000.00 per year

Benefits:

Provident Fund
Work Location: In person