Complete RCM services Specialist

5 days ago

Lahore, Punjab, Pakistan Jawa Health Care Full time 1,920,000 - 3,600,000 per year

Job Summary:

The RCM Services Specialist is responsible for managing the end-to-end revenue cycle process, including patient registration, insurance verification, charge entry, claims submission, payment posting, denial management, and accounts receivable follow-up. This role ensures that all revenue cycle processes are conducted accurately, efficiently, and in compliance with payer guidelines and healthcare regulations.

Key Responsibilities:1. Front-End RCM

  • Perform patient registration and verify demographics and insurance details.
  • Ensure accurate and timely insurance eligibility and benefit verification.
  • Obtain prior authorizations and pre-certifications when required.

  • Educate patients on insurance coverage, copays, deductibles, and financial responsibility.

  • Mid-Cycle RCM

  • Review clinical documentation and ensure proper charge capture.

  • Enter and audit charges for accuracy and completeness.
  • Ensure compliance with CPT, ICD-10, and HCPCS coding standards.

  • Collaborate with clinical staff and coders to resolve discrepancies.

  • Back-End RCM

  • Submit clean claims electronically or via paper, ensuring payer-specific requirements are met.

  • Monitor claim rejections and denials; correct and resubmit in a timely manner.
  • Post payments from insurance companies and patients; reconcile with Explanation of Benefits (EOBs).
  • Manage accounts receivable (A/R) and perform timely follow-ups on unpaid or underpaid claims.
  • Handle patient billing inquiries and collections professionally and sensitively.

Qualifications:

  • Bachelor's degree in healthcare administration, business, or related field preferred.
  • High school diploma or GED required.
  • Certification in medical billing/coding (e.g., CPC, CCS, CPB) is a plus.
  • Minimum 2–4 years of experience in healthcare revenue cycle operations.
  • Experience with RCM tools, billing systems (e.g., Epic, Cerner, Kareo, Athenahealth), and clearinghouses.
  • Familiarity with Medicare, Medicaid, and commercial insurance payers.

Skills and Competencies:

  • Technical Skills: Proficiency in MS Office Suite and EHR/PM systems.
  • Knowledge Base: Strong understanding of medical terminology, coding (CPT, ICD-10), and payer guidelines.
  • Analytical Skills: Ability to identify claim issues, analyze denial trends, and resolve billing problems.
  • Communication: Strong verbal and written communication skills.
  • Detail-Oriented: High attention to detail and accuracy in data entry and documentation.
  • Time Management: Ability to prioritize tasks and meet deadlines in a fast-paced environment.
  • Team Collaboration: Works well in a team environment and collaborates across departments.

Preferred Experience:

  • Previous work in a multi-specialty practice, hospital, or billing service provider.
  • Experience with value-based care metrics and risk-adjusted coding.
  • Familiarity with HIPAA compliance and regulatory standards.

Work Environment & Physical Requirements:

  • May require prolonged sitting, extensive use of a computer, and telephone.
  • [Specify if remote work is allowed or if travel is required.]

Performance Metrics:

  • Claims first-pass rate
  • Denial rate and resolution time
  • Days in A/R
  • Collection rate
  • Patient satisfaction scores (for billing inquiries)

Job Type: Full-time

Pay: Rs80, Rs150,000.00 per month

Work Location: In person

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