RCM Specialist

Job description

The RCM Specialist is responsible for providing end-to-end Revenue Cycle Management (RCM) operational support to healthcare providers utilizing the employer's RCM solutions. The role manages the complete revenue cycle, ensures compliance with healthcare regulations and payer requirements, resolves claim-related issues, and collaborates with hospital and internal teams to maximize collections, improve operational efficiency, and deliver high-quality RCM services. Education: Bachelor’s in: Health Informatics,Healthcare Administration / Hospital Management, Business Administration, Management Information Systems

Requirements

• Fluent in English (spoken & written).
• Advanced Excel skills and data analysis.
• Hands-on experience managing the full Revenue Cycle Management (RCM) process end-to-end (A-Z), including registration, eligibility, pre-authorization, charging, coding, billing, claims submission, rejection management, follow-up, and collections.
• Strong knowledge of Medical Claims, Billing, and Health Insurance Operations.
• Good knowledge of Hospital Information Systems (HIS) and Claims Management Systems.
• Strong knowledge of CCHI regulations, requirements, and healthcare insurance compliance standards.
• Good understanding of CBAHI requirements and healthcare quality standards.
• Ability to identify root causes of claim rejections and implement corrective actions to improve collections.
• Strong analytical, communication, and problem-solving skills.
• Ability to work effectively with cross-functional teams.

Skills