RCM AR Specialist

LE9220 Veradigm India Private Limited - Pune; Pune District; Hybrid; INR 600,000 - 800,000; Full time

Benefits offered by this job

Quarterly recharge days

Tuition reimbursement

Peer-based incentive awards

Job summary

LE9220 Veradigm India Private Limited in Pune is seeking a professional to oversee accounts receivable, maximizing collections and managing claims. Responsibilities include detailed research on insurance claims, preparing appeals, and supporting operations.

The ideal candidate has experience with billing systems, strong customer service skills, and knowledge of current payer regulations. This role offers flexible working arrangements and a generous benefits package focused on work/life balance.

Qualifications

• Extensive knowledge of payer websites and Laserfiche.
• Experience in specialties including psychiatry and orthopedics.
• Familiarity with Medicare Fee-for-Service plans.

Responsibilities

• Conduct detailed research on medical insurance claims.
• Prepare appeals to interact with insurance carriers.
• Manage unpaid claims using aging reports.

Skills

Knowledge of email and search engines

Microsoft Office competence

Experience with billing systems

Customer service skills

Tools

MS Access

PowerPoint

Crystal Reports

Job description

Overview

Responsible for the overall recovery and management of accounts receivable to maximize collections for RCMS clients. The role involves detailed research and follow‑up on medical insurance claims, preparation of appeals and responses to efficiently interact with insurance carriers and resolve claims.

Responsibilities

• Conduct detailed research and follow‑up on medical insurance claims.
• Prepare appeals and responses to interact with insurance carriers and resolve claims.
• Support RCMS BU's Operations and Client Services by driving the accounts receivable process and achieving KPI results.
• Answer client, patient and carrier calls; promptly return and follow up on all interactions and requests for information.
• Manage unpaid claims using aging reports, correspondence, clearinghouse and PM rejections; maintain SharePoint references.
• Handle complex payer denials and ensure secondary claims are processed and paid.
• Monitor and reconcile claims including held vouchers, unbilled vouchers, denial trends, patient balance reports, credits and refunds.
• Track and resolve information requests from clients.
• Enforce policies and procedures and meet RCM management goals for error‑free work, transactions, productivity and compliance.
• Work toward 1,400 accounts per month and assist new hires as a partner in learning.
• Perform other duties as assigned.

Qualifications and Skills

• Extensive knowledge of email, search engines, Internet, payer websites and Laserfiche.
• Basic competence in Microsoft Office products.
• Preferred experience with MS Access, PowerPoint and Crystal Reports.
• Experience with billing systems such as NextGen, Pro, Allscripts, Epic and others.
• Knowledge of CPT, ICD‑10 and modifiers.
• Experience in specialties including psychiatry, internal medicine, orthopedics, general surgery.
• Familiarity with HMO and IPA, Medicare Fee‑for‑Service plans and commercial payers.
• Excellent customer‑service skills.

Working Arrangements

Standard work week unless otherwise defined; works primarily in a standard office environment or remotely. May require after‑hours, on‑call support and/or holidays. On‑call and after‑hours work during peak times (end of month/quarter/year) and PTO is limited during these periods.

Benefits

Veradigm offers a generous benefits package with an emphasis on work/life balance, including quarterly company‑wide recharge days, peer‑based incentive “Cheer” awards, and a tuition reimbursement program.

Equal Opportunity Statement

Veradigm is proud to be an equal‑opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.