RCM-AR Specialist-Denial Management/US Healthcare

RCM Analyst is responsible for handling complex and escalated claims within the US Healthcare Revenue Cycle Management (RCM) process. The team ensures efficient resolution of denied or aged claims, identifies root causes of payment delays, and implements corrective actions to improve revenue recovery. Must display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership.

This role is crucial for improving cash flow, reducing bad debt, and ensuring financial stability for healthcare providers by optimizing the revenue cycle process.

This role is crucial for improving cash flow, reducing bad debt, and ensuring financial stability for healthcare providers by optimizing the revenue cycle process.

Primary Responsibilities:

• Review outstanding insurance balances to identify and resolve issues preventing finalization of claim payment, including coordinating with payers, patients and clients when appropriate
• Analyze and trend data, recommending solutions to improve first pass denial rates and reduce age of overall AR
• Investigate and resolve denied, aged, or complex medical claims to maximize reimbursement.
• Accounts Receivable Specialist that has an "understanding" of the whole accounting cycle / claim life cycle
• Ensure all workflow items are completed within the set turn-around-time within quality expectations
• Able to analyze EOBs and denials at a claim level in addition they should find trends impacting dollar and leading to process improvements
• Perform other duties as assigned
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment).
• The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
• Proven experience in Physician Billing -CMS1500. Hospital Billing -UB04 Claims will be an added advantage
• Responsible for handling complex and escalated claims within the US Healthcare Revenue Cycle Management (RCM) process.

Internal Required Qualifications:

• Should be a Graduate (10+2+3)
• 3 Years and above experience in healthcare accounts receivable required (Denial Management)
• Solid knowledge of medical insurance (HMO, PPO, Medicare, Medicaid, Private Payers)
• In-depth working knowledge of the various applications associated with the workflows

Required Knowledge / Skills / Abilities Qualifications:

• Solid knowledge and use of the American English language skills with neutral accent
• Ability to communicate effectively with all internal and external clients
• Ability to use good judgment and critical thinking skills; ability to identify and resolve problems
• Experience with revenue cycle software and electronic health record (EHR) systems.
• Proficiency in Excel, SQL, Power BI, or Tableau for reporting preferred
• Advance Excel and strong ability to analyze data, identify patterns.
• Understanding of CPT, ICD-10, HCPCS and payer billing reimbursement methods
• Proficient in MS Office software; particularly Excel and Outlook
• Efficient and accurate keyboard/typing skills
• Solid work ethic and a high level of professionalism with a commitment to client/patient satisfaction
• Functional knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information

Soft skills:

• Strong leadership, communication, and team management abilities.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong understanding of US healthcare RCM processes (Billing, Coding, Denials, AR, Payments, Compliance)
• Strong knowledge of medical billing, coding (CPT, ICD-10, HCPCS), payer contracts, and reimbursement methodologies.
• Knowledge of regulatory compliance, including HIPAA and healthcare financial regulations.
• Knowledge of RCA tools and their effectiveness

If you are passionate about healthcare and meet the required criteria, we encourage you to attend and share this opportunity with your friends or colleagues who might be interested.

Interview Venue:Optum (UnitedHealth Group)

aVance; Phoenix Infocity Private Ltd SEZ

Site-5; 3rd Floor- Building No. H06A

HITEC City 2, Hyderabad-500081
Date: 01-July-2025

Time: 11:00 AM

Point Of Contact: Lakshmi Deshapaka

Email: deshapaka_vijayalakshmi1@optum.com

Things to Carry:

• Updated resume
• Government-issued photo ID (e.g., Aadhaar, Passport, or Driver's License)
• Passport-size photographs (2)

• Dress Code - Business Formals

Looking forward to seeing you and your referrals at the drive!

Please Note:

• Entry will be allowed only after showing the physical copy of this interview invite
• Kindly Ignore if you have appeared for a walk-in drive with us in the last 30 Days. If you have no experience in AR Calling (Voice Process)-Denial Management & not open to night shifts!