Professional, RCM

Key Responsibilities Process and manage the complete revenue cycle, including charge entry, claim submission, payment posting, denial management, and AR follow-up. Review claim rejections and denials, identify root causes, and take corrective actions for timely reimbursement. Follow up with commercial, Medicare, Medicaid, and Workers' Compensation payers through portals and phone calls. Analyze Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA) to ensure accurate payment posting. Resolve underpayments, coding edits, authorization issues, eligibility errors, and documentation deficiencies. Escalate complex billing issues to Coding, Credentialing, Client Success, or Practice Management teams when required. Monitor aging reports and prioritize high-value accounts to reduce outstanding AR. Meet productivity, quality, and turnaround time (TAT) targets. Prepare daily, weekly, and monthly operational reports and communicate key performance metrics. Identify process improvement opportunities to improve First Pass Payment Rate (FPPR), reduce denials, and improve cash collections. Train and mentor junior associates while providing guidance on payer-specific billing requirements. Ensure compliance with HIPAA, payer policies, and client-specific standard operating procedures (SOPs)