Job Summary:
We are seeking experienced and customer-focused Revenue Cycle Associates to support our US Healthcare Revenue Cycle Management (RCM) voice operations. The ideal candidate will have hands-on experience interacting with insurance payers, healthcare providers, and patients to resolve billing and claims-related issues. This role requires excellent communication skills, strong knowledge of the US healthcare reimbursement process, and the ability to resolve issues efficiently while maintaining high standards of compliance, quality, and customer service.
Supervisory Responsibilities:
This position has no direct supervisory responsibilities.
Duties/Responsibilities:
Contact insurance companies, healthcare providers, and patients to resolve claim, billing, eligibility, authorization, payment, and denial-related issues.
Make and receive professional outbound and inbound calls while adhering to client and regulatory guidelines.
Research unpaid, underpaid, denied, or rejected claims and take appropriate action for resolution.
Verify insurance eligibility, benefits, claim status, prior authorizations, and payment information.
Analyze payer responses and determine the next appropriate course of action, including claim corrections, resubmissions, or appeals.
Document all call activities accurately in client systems and maintain complete account notes.
Utilize payer portals and practice management systems to support account resolution.
Meet productivity, quality, and service level expectations while maintaining high call quality standards.
Escalate complex issues appropriately to supervisors or client contacts.
Participate in induction, client-specific training, refresher programs, and continuous learning initiatives.
Identify process improvement opportunities and proactively contribute to operational excellence.
Ensure compliance with HIPAA, client requirements, and organizational policies.
Performs other duties as assigned.
Required Skills/Abilities:
Minimum 1–3 years of experience in US Healthcare Revenue Cycle Management (RCM).
Experience handling inbound and outbound calls with insurance companies, healthcare providers, or patients.
Strong understanding of Patient Registration, Insurance Eligibility Verification, Medical Billing , Accounts Receivable (AR), and Denial Management.
Knowledge of claim denials, rejections, appeals, payer policies, and reimbursement methodologies.
Familiarity with ANSI 835 Electronic Remittance Advice (ERA), Explanation of Benefits (EOB), and payer portals.
Working knowledge of HIPAA regulations and medical billing terminology, including CPT, ICD-10, and HCPCS codes.
Excellent verbal communication, listening, negotiation and customer service skills.
Proficiency in Microsoft Office applications and healthcare practice management systems.
Preferred Skills
Experience in Physician Billing, Hospital Billing, or Revenue Cycle Operations.
Knowledge of Medicare, Medicaid, Commercial, Managed Care, and Workers’ Compensation payers.
Experience working with multiple-payer portals and EMR/EHR systems.
Strong problem-solving, conflict resolution, and relationship management skills.
Ability to handle difficult conversations professionally while maintaining a positive customer experience.
Core Competencies
Excellent verbal communication, Customer service orientation, Active listening
Negotiation and influencing skills, Analytical thinking, Problem-solving, Time management, Attention to detail, Team collaboration, Adaptability and continuous learning, Accountability and ownership, Professionalism and integrity
Performance Expectations
Achieve defined productivity, quality, and customer satisfaction targets.
Maintain high first-call resolution and account resolution rates wherever applicable.
Ensure timely follow-up on pending accounts.
Maintain accurate documentation with minimal errors.
Adhere to HIPAA, compliance standards, and client-specific processes.
Demonstrate ownership, reliability, and a commitment to delivering exceptional service.
Education and Experience:
High school diploma or GED required
Minimum 2 years of healthcare Revenue Cycle Management, medical billing, accounts receivable, denials, or appeals experience.
Knowledge of commercial, Medicare, Medicaid, and Managed Care payer requirements.
Experience working with EOBs, ERAs, payer portals, and claims adjudication processes.
Physical Requirements:
