Product Development

Position Overview

We are seeking a Process Analyst / Subject Matter Expert (SME) to provide deep domain expertise in the full US Healthcare Revenue Cycle Management (RCM) lifecycle, driving process optimization, AI/ML adoption, automation, and operational excellence. The role spans the entire RCM cycle: Patient Registration → Eligibility & Benefits → Prior

Authorization → Coding & Documentation → Charge Capture → Claims Submission → Payment Posting → Denial Management → Collections & Reporting.

The SME will focus on full RCM workflows, payer systems, EHR/EMR/PMS integrations, EDI transactions, coding standards, payer portals, and payer databases (e.g., NCCi, AAPC, AHIMA, AMA), ensuring compliant, scalable, and data-driven RCM operations and supporting analytics, AI/automation, and dashboard/reporting initiatives for US healthcare operations.

The role collaborates with business analysts, data scientists, RPA engineers, AI/ML teams, system/application analysts & developers, and clients to implement AI-driven process improvements.

Job Roles & Responsibilities





End-to-End RCM Process Expertise:

 Analyze and optimize full RCM workflows, including Patient Registration, Eligibility Verification,

Prior Authorization, Coding, Charge Capture, Claims Submission, Payment Posting, Denial

Management, Collections, and Reporting.

 Map detailed process flows, exceptions, and system interactions for RCM operations.

 Maintain best-practice SOPs aligned with compliance, AI/automation, and system integrations.

 Leverage knowledge of payer databases, payer websites, and industry standards (NCCi, AAPC,

AHIMA, AMA) to validate claims and workflows.

 Serve as domain expert across the full RCM cycle:

Patient Registration & Scheduling
Eligibility & Perks Verification
Prior Authorization
Medical Coding (ICD-10, CPT, HCPCS)
Claims Submission & Management
Denials Management & Collections
Revenue Reconciliation & Financial Reporting

 Identify process g

📌 SENIOR MANAGER (Pune)
🏢 Innoval Global Solutions
📍 Pune