? We're Hiring | US Healthcare RCM SpecialistExperience: 1–5 Years | US Healthcare RCM We are looking for candidates with hands-on experience in US Healthcare Revenue Cycle Management (RCM), particularly in Prior Authorization, Insurance Verification, Medical Billing, Claims Management, Denial Management, AR Follow-up, and Medical Coding. The ideal candidate should have practical experience working with US healthcare providers, insurance companies, and payer portals, with a good understanding of RCM operations.

Key Responsibilities
1. Prior Authorization
• Handle prior authorization requests for medical procedures, services, and medications.
• Verify authorization requirements with insurance companies.
• Follow up with payers on pending authorization requests.
• Resolve authorization-related issues. 2. Insurance Eligibility & Benefits Verification
• Verify patient insurance eligibility and coverage.
• Check copayments, deductibles, coinsurance, and out-of-pocket expenses.
• Verify insurance benefits through payer portals and insurance calls.
• Identify coverage limitations and authorization requirements. 3. Medical Billing & Claims Management
• Prepare and submit professional healthcare claims using CMS-1500 and electronic 837P formats.
• Review claims for accuracy before submission.
• Identify and correct billing errors and claim rejections.
• Resubmit corrected claims and monitor claim status.
• Understand Medicare, Medicaid, and commercial payer billing guidelines. 4. Denial Management & Appeals
• Review, analyze, and resolve insurance claim denials.
• Identify denial reasons and determine appropriate corrective actions.
• Understand CARC, RARC, and Group Codes.
• Prepare and submit appeals with supporting medical documentation.
• Follow up on pending appeals and track appeal outcomes. 5. Accounts Receivable (AR) Follow-up
• Perform insurance AR follow-up through calls and payer portals.
• Contact insurance companies regarding outstanding and unpaid claims.




• Follow up on denied, underpaid, and delayed claims.
• Resolve payment discrepancies and outstanding balances.
• Maintain AR aging reports and ensure timely follow-up. 6. Medical Coding
• Understand ICD-10-CM, CPT, and HCPCS coding.
• Review medical claims for coding accuracy.
• Understand modifiers, NCCI edits, and MUE guidelines.
• Identify common coding errors that lead to claim rejections and denials.
• Understand LCD and NCD guidelines. Required Skills & Experience
• 1–5 years of hands-on experience in US Healthcare RCM.
• Practical experience in at least 2–3 of the following areas:
• Prior Authorization
• Insurance Eligibility & Perks Verification
• Medical Billing
• Claims Processing and Management
• Denial Management
• Appeal Management
• Insurance AR Follow-up / AR Calling
• Medical Coding
• Good understanding of Medicare, Medicaid, and commercial insurance.
• Knowledge of CMS-1500, 837P, 835, ICD-10, CPT, and HCPCS.
• Experience working with insurance portals and payer guidelines.
• Strong problem-solving and analytical skills. Communication RequirementsGood English communication is mandatory. Candidates must be comfortable speaking with US insurance representatives, handling payer calls, explaining claim-related issues, and communicating effectively with healthcare providers and internal teams. Who Should Apply?Candidates currently working in US Healthcare RCM operations, medical billing companies, healthcare BPOs, or RCM service organizations. Important: We are specifically looking for candidates with actual hands-on experience in US Healthcare RCM operations. Candidates with only general healthcare knowledge, non-US healthcare experience, or generic customer support experience will not be considered. ? Interested candidates can share their updated resumes at [email protected] or reach out directly. #Hiring #HealthcareRCM #PriorAuthorization #InsuranceVerification #MedicalBilling #ClaimsManagement #DenialManagement #AppealManagement #ARFollowUp #MedicalCoding

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