Medical Billing / A/R / RCM Specialist US Healthcare

Job Type: Full-time
Experience: 3–7 years
Work Mode: Remote
Industry: US Healthcare / Medical Billing / Revenue Cycle Management

Job Summary

We are looking for an experienced Medical Billing / Accounts Receivable (A/R) / Revenue Cycle Management (RCM) Specialist with hands-on experience in US Healthcare Medical Billing, insurance claims, denial management, A/R follow-up, medical coding, and provider credentialing.

The ideal candidate should have strong knowledge of the US Healthcare Revenue Cycle, including insurance and patient billing, claims processing, payment posting, denial resolution, collections, coding and billing accuracy, and insurance follow-up. Experience with provider credentialing and payer enrollment will be highly preferred.

Key Responsibilities

- Handle end-to-end US Healthcare Medical Billing and Revenue Cycle Management (RCM) activities.
- Manage insurance billing and patient billing processes.
- Perform Accounts Receivable (A/R) management and insurance claim follow-up.
- Track outstanding claims, unpaid claims, denials, underpayments, and delayed payments.
- Follow up with insurance companies through payer portals, phone calls, and other communication channels.
- Investigate and resolve claim denials, rejections, payment delays, and underpayments.
- Prepare and submit appeals, reconsiderations, and corrected claims as required.
- Perform payment posting using EOBs and ERAs and maintain accurate patient account balances.
- Support patient payments and collections, including review of patient responsibility and outstanding balances.
- Review claims and billing information before submission to ensure billing accuracy and completeness.
- Verify patient eligibility, advantages, insurance coverage, and prior authorization requirements.
- Review medical documentation and coding information to identify potential billing or coding discrepancies.
- Ensure accurate medical coding, charge entry, CPT,



ICD-10-CM, HCPCS, modifiers, and diagnosis/procedure information where applicable.
- Coordinate with coding, billing, clinical, and administrative teams to resolve claim-related issues.
- Maintain accurate claim, payment, A/R, denial, and follow-up records.
- Monitor A/R aging and prioritize accounts based on aging, dollar value, denial status, timely filing limits, and recovery potential.
- Track billing and payment activity and provide information required for monthly revenue reporting and RCM reporting.
- Identify recurring denial trends and recommend process improvements to reduce claim denials and payment delays.
- Support provider credentialing, payer enrollment, and recredentialing activities.
- Maintain provider credentialing documentation and track application/enrollment status with insurance payers.
- Assist with maintaining provider information, licenses, certifications, NPI, CAQH and other credentialing-related records.
- Follow up with payers regarding provider enrollment, credentialing, contracting, and participation status.
- Maintain confidentiality and comply with applicable healthcare data privacy and security requirements.

Required Skills & Experience

- 3–7 years of experience in US Healthcare Medical Billing / RCM / A/R.
- Strong hands-on experience with:
- Medical Billing
- Insurance Billing
- Patient Billing
- A/R Follow-Up
- Claims Processing
- Denial Management
- Payment Posting
- EOB / ERA
- Insurance Verification
- Eligibility & Benefits Verification
- Prior Authorization
- Appeals & Reconsiderations
- Patient Collections





- Working knowledge of Medical Coding, including CPT, ICD-10-CM and HCPCS.
- Experience reviewing claims and billing information for coding and billing accuracy.
- Experience with provider credentialing, payer enrollment, recredentialing, or insurance enrollment is preferred.
- Knowledge of CAQH, NPI, payer enrollment and provider credentialing processes will be an advantage.
- Experience working with US insurance payers such as UHC, Aetna, Cigna, BCBS, Medicare, Medicaid, etc.
- Experience using insurance portals such as Availity and payer-specific portals.
- Good knowledge of the US Healthcare Revenue Cycle.
- Strong analytical, communication, documentation, and follow-up skills.
- Ability to work independently and manage multiple accounts and priorities.

Preferred Software / Tools

Experience with any of the following will be an advantage:

EMR / EHR / Billing: EMA / ModMed, Kareo, Cerner, Meditech, HealthFusion, or similar systems.

Payer Portals: Availity, UHC, Aetna, Cigna, BCBS, Medicare, Medicaid and other payer portals.

Office Tools: MS Excel, Word, Outlook and PowerPoint.

Key Performance Areas / KPIs

- A/R Aging Reduction
- Claim Resolution Rate
- Denial Rate
- Clean Claim Rate
- Payment Posting Accuracy
- Claim Follow-Up
- Collection Rate
- Days in A/R
- Underpayment Recovery
- Timely Claim Submission
- Credentialing / Enrollment Turnaround
- Billing Accuracy
- Monthly Revenue / RCM Reporting

Candidate Profile

We are looking for someone who is hands-on, detail-oriented, analytical, and comfortable taking ownership of the complete billing and A/R process. The candidate should be able to investigate claim issues independently, communicate effectively with US insurance payers, identify the root cause of denials, and ensure timely reimbursement.

Candidates with a combination of Medical Billing + A/R + Medical Coding + Provider Credentialing experience will be strongly preferred.

📌 Medical Billing / A/R / RCM Specialist US Healthcare (Delhi)
🏢 Legelp Services
📍 Delhi