Revenue Cycle Management Associate
Job Summary
The Revenue Cycle Management Associate is responsible for managing and resolving denied, rejected, and unpaid insurance claims to support timely reimbursement and optimize revenue cycle performance. This role involves claims follow-up, payer communication, appeals processing, and clearinghouse resubmissions. The position requires close coordination with healthcare providers and insurance companies to ensure accurate and efficient claims resolution.
Responsibilities
- Resolve denied/rejected insurance claims
- Contact payers for status and appeals
- Perform AR follow-up
- Coordinate with healthcare providers
Required Skills
- Revenue cycle management experience
- Medical billing knowledge
- Proficiency in MS Office
- Strong analytical and communication skills
Job Details
Job Responsibilities:
- Review, analyze, and resolve denied or rejected insurance claims.
- Contact insurance companies to verify claim status and appeal claim denials.
- Prepare, correct, and resubmit claims through clearinghouse systems.
- Perform accounts receivable (AR) follow-up for outstanding claims and unpaid balances.
- Coordinate with hospitals, clinics, providers, and insurance payers regarding billing and reimbursement concerns.
- Monitor claim adjudication, reimbursement, and payment status.
- Maintain accurate documentation of claim actions, payer communications, and appeal outcomes.
- Identify root causes of claim denials and recommend corrective actions to reduce recurring issues.
- Ensure compliance with client productivity, accuracy, and quality standards.
- Escalate complex claims, payer disputes, or unresolved billing issues when necessary.
Qualifications:
- Bachelor’s degree preferred; equivalent work experience may be considered.
- Experience in revenue cycle management, medical billing, or healthcare claims processing.
- Knowledge of insurance claims, EOBs, denial management, and AR follow-up processes.
- Familiarity with clearinghouse systems and healthcare billing platforms.
- Understanding of CPT, ICD, and HCPCS coding basics is an advantage.
- Strong analytical, problem-solving, and communication skills.
- Ability to manage multiple claims and meet productivity targets in a fast-paced environment.
- Proficiency in MS Office and healthcare-related systems/tools.
- Experience handling commercial and government insurance payers.
- Strong attention to detail and documentation accuracy.
- Ability to work independently and collaboratively within a team environment.
- Effective verbal and written communication skills for payer and provider interactions.