Senior Rural Health Clinic (RHC) Biller

OptiClaim LLP; India; Sur place; INR 900 000 - 1 500 000; Plein temps

Résumé du poste

OptiClaim LLP is hiring a Senior Rural Health Clinic (RHC) Biller to independently manage end-to-end billing for RHC encounters, ensuring accurate claims and compliance with Medicare RHC rules. The role requires hands-on experience with UB-04/837I, billing configurations, and issue resolution to drive accounts to completion.

The ideal candidate will review documentation, codes, charges, and claim details, identifying gaps and ensuring clean submissions while collaborating with EMR and

Qualifications

• Extensive hands-on healthcare billing experience in Rural Health Clinic billing.

Responsabilités

• Independently perform end-to-end billing and claim production for Rural Health Clinic encounters, ensuring accurate payer-specific RHC billing.

Connaissances

RHC billing

End-to-end billing

Medicare RHC billing

Attention to detail

Independent worker

Communication skills

Formation

CPC or CCS certification (AAPC)

Outils

EMR systems

Billing software

Description du poste

OptiClaim provides medical coding, billing and revenue cycle services to US healthcare providers. We are hiring a Senior RHC Biller to bill Rural Health Clinic encounters for a US rural healthcare client, from encounter review to claim submission.

Position Summary

We are seeking a highly experienced Senior Rural Health Clinic (RHC) Biller with specific, practical experience billing services under the Rural Health Clinic methodology. This is not a general physician-office billing position and is not an advisory-only role. The successful candidate is expected to independently perform the billing work: determine how encounters should be billed, identify and enter required charges and claim elements, produce accurate claims, resolve billing issues, and drive assigned accounts to completion. The individual must be able to operate independently in an evolving environment while recognizing workflow or system gaps and providing clear, practical feedback that improves RHC billing accuracy and efficiency.

Key Responsibilities

• ·Independently perform end-to-end billing and claim production for Rural Health Clinic encounters, including determining, entering, validating, and correcting the information and charges required for accurate payer-specific RHC billing.
• ·Apply practical knowledge of Medicare RHC billing methodology and recognize when an encounter should follow RHC-specific billing rules rather than standard physician-office billing.
• ·Review documentation, coding, charges, provider information, encounter details, and claim configuration for completeness before submission.
• ·Understand institutional RHC claim requirements, including UB-04/837I billing concepts, appropriate revenue-code usage, qualifying visit considerations, and payer-specific claim requirements.
• ·Understand when professional claim workflows may also apply for services or payers and recognize the operational distinction between RHC and standard clinic billing.
• ·Review CPT/HCPCS and diagnosis coding from a billing perspective and identify documentation, coding, charge, or configuration issues that may prevent correct reimbursement.
• ·Recognize RHC-specific billing issues such as incorrect claim type, missing qualifying visit information, incorrect revenue-code mapping, inappropriate claim configuration, or payer-specific requirements.
• ·Perform manual charge entry, claim creation, claim correction, and account reconciliation whenever required to ensure RHC encounters are billed completely and accurately.
• ·Research and resolve billing edits, rejections, and denials and identify whether the root cause is operational, coding-related, payer-related, or system-related.
• ·Take ownership of RHC billing issues and obtain or resolve the information necessary to complete accurate claims and move assigned accounts through billing.
• ·Communicate RHC billing requirements directly to EMR and billing-system developers, including required data fields, claim logic, charge/revenue-code mappings, edits, payer rules, and workflow needs.
• ·Test RHC billing scenarios and validate claim output as new functionality is developed, ensuring the system supports real-world RHC billing rather than a standard clinic-only workflow.
• ·Track productivity, unresolved accounts, denial/rejection patterns, recurring system gaps, and revenue-impacting issues and provide organized recommendations for improvement.

Required Qualifications

• ·Extensive hands-on healthcare billing experience in the specialty/setting described for this position; this is not an entry-level role.
• ·Strong practical coding knowledge and the ability to understand how documentation, coding, charges, revenue codes, claim fields, and reimbursement connect.
• ·Demonstrated ability to independently produce claims, review charges, identify missing or incorrect billing elements, resolve edits, and follow claims through the billing cycle.
• ·Ability to work effectively when workflows are not fully automated, including performing accurate manual billing and charge review when necessary.
• ·Ability to learn unfamiliar EMRs and billing applications quickly and adapt to changing workflows.
• ·Strong written and verbal communication skills, including the ability to translate billing requirements into clear functional feedback for EMR, billing software, and development teams.
• ·High attention to detail, strong ownership, and the ability to work independently with limited supervision.
• ·Substantial direct Rural Health Clinic billing experience; general physician-office billing experience alone is not sufficient.
• ·Strong knowledge of Medicare RHC billing and reimbursement concepts and the ability to apply RHC-specific requirements in day-to-day claim production.
• ·Working knowledge of UB-04/837I billing in the RHC environment, revenue-code concepts, CPT/HCPCS coding, and payer-specific billing requirements.
• ·Ability to distinguish RHC billing workflows from standard clinic/professional billing and identify when configuration or claim logic is incorrect.
• ·CPC or CCS certification (AAPC billing certification)

Preferred Qualifications

• ·Experience participating in an EMR, practice management, patient accounting, or billing-system implementation, conversion, build, testing, or optimization project.
• ·Experience creating workflow requirements, testing system functionality, identifying defects or missing functionality, and validating billing outputs.
• ·Experience working directly with technical, implementation, or software development teams.
• ·Experience billing RHC services for Medicare, Medicaid, Medicare Advantage, managed care, and commercial payers.
• ·Experience with RHC claim audits, denial resolution, reimbursement validation, or payer-specific billing configuration.
• ·Experience helping configure or test an EMR/practice-management/patient-accounting system for an RHC or other provider-based clinic environment.

What Success Looks Like

• ·RHC claims are produced correctly without treating the clinic as a standard physician-office billing environment.
• ·The biller independently identifies payer, coding, claim-configuration, and system issues before they create recurring denials or underpayments.
• ·Manual workflows are handled accurately while automation is being developed.
• ·RHC-specific requirements are translated into clear, testable requirements for the EMR/billing development team.
• ·The individual serves as the senior billing subject-matter expert while continuing to perform day-to-day production work.

All work follows HIPAA. OptiClaim is an equal opportunity employer.

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