We're Hiring | Healthcare RCM Business Analyst / Functional SME

Experience: 1–5 Years | US Healthcare RCM

We are looking for an experienced Healthcare RCM Business Analyst / Functional SME with strong hands-on knowledge of US Healthcare Revenue Cycle Management, particularly Medical Coding, Billing, Denial Management and Appeal Management.

The ideal candidate should be capable of independently understanding complex RCM workflows, documenting business requirements, and working closely with technical teams to identify opportunities for process improvement and AI-driven automation.

Key Responsibilities:

- Understand and document the end-to-end US Healthcare RCM lifecycle.
- Have strong knowledge of Medical Coding, Billing, Claims Processing, Payment Posting, AR Management (insurance and patient payment management), Denial Management and Appeals.
- Gather business requirements and independently prepare BRDs, FRDs, SOPs and functional specifications.
- Create detailed process flows, workflow diagrams, business rules and decision matrices.
- Understand denial categories, CARC, RARC, Group Codes and payer-specific appeal processes.
- Identify opportunities for AI and automation across billing, denial management and appeals.
- Translate business requirements into functional specifications, user stories and acceptance criteria.
- Work closely with developers, QA teams and business stakeholders.
- Conduct requirement-gathering sessions, process walkthroughs and knowledge-transfer sessions.
- Support functional testing and User Acceptance Testing (UAT).

Required Skills & Experience:

- 5–10 years of experience in US Healthcare RCM.
- Solid practical knowledge of Medical Billing,



Denial Management and Appeal Management.
- Experience in business analysis and functional documentation.
- Excellent understanding of Medicare, Medicaid and commercial payer workflows.
- Knowledge of ICD-10, CPT, HCPCS, 837, 835, 270/271 and 276/277 transactions.
- Basic understanding of REST APIs, JSON, HL7 FHIR and healthcare integrations.
- Exposure to AI/ML, LLMs, OCR and healthcare automation is preferred.
- Experience working with development and QA teams.

Excellent English Communication is Mandatory The candidate must be confident in conducting business discussions, gathering requirements, explaining complex RCM workflows, preparing professional documentation and presenting solutions to both technical and non-technical stakeholders.

Expected Deliverables:

The candidate should be able to independently own and deliver:

- End-to-end RCM process documentation.
- BRDs, FRDs and functional specifications.
- Medical Billing, Denial and Appeal Management workflows.
- AI and automation requirement documents.
- Business rules, decision matrices and process flow diagrams.
- User stories, acceptance criteria and UAT documentation.
- SOPs and knowledge-transfer materials.

- Who Should Apply? Professionals with a strong US Healthcare RCM background who are looking to contribute to business analysis, process transformation and AI-driven healthcare automation.

Interested candidates can share their updated resumes to [email protected] or reach out to me directly.

Please feel free to share this post with anyone who may be a good fit!

#Hiring #HealthcareRCM #BusinessAnalyst #MedicalBilling #DenialManagement #AppealManagement #HealthcareIT #AIinHealthcare #USHealthcare

📌 We're Hiring | Healthcare RCM Business Analyst / Functional SME (India)
🏢 gingerCube
📍 India