Process Analyst - RCM AR

AR - RCM

An AR RCM Analyst manages healthcare accounts receivable by following up on claims, resolving denials (calling payers/using portals/ sending emails), analyzing Aging buckets and improving cash flow. Key tasks involve Claim submission, appeals, data Analysis (Excel), and maintaining records in tools, focusing on timely collections and reducing AR days.

Key Responsibilities

• Claim Submission & Follow-up: Extract , Validate , submit and follow up on claims (hospital/facility) with insurance companies via calls, emails or web portals.
• Denial & Rejection Resolution: Analyze denials, work appeals, correct coding, and reprocess claims for payment.
• Accounts Receivable (AR) Analysis: Monitor AR aging, identify trends, perform root cause analysis for denials
• Documentation & Reporting: Maintain accurate records, document actions, and generate reports on billing activities and performance.
• Compliance & Quality: Ensure adherence to payer guidelines, HIPAA, and industry best practices; self-audit for quality.
• Collaboration: Coordinate with internal teams (billing, coding, clinical) and external parties (providers, payers). 

Required Skills & Qualifications

• Experience: 5+ years experience in US Healthcare RCM, Medical Billing, Denial Management.
• Software: Proficiency with EPIC and similar tools , MS Excel.
• Knowledge: Good understanding of ICD-10, CPT, healthcare regulations, UB04.
• Analytical Skills: Ability to analyze data, identify patterns, and solve complex problems.
• Communication: Excellent verbal skills for payer calls and written skills for sending emails and follow-ups.