Revenue Cycle Management Specialist at MeshSquare in Lahore

e are seeking an experienced and detail-oriented US Revenue Cycle Management (RCM) Specialist with strong hands-on experience across the medical billing lifecycle, including Charge Entry, Claims Processing, Accounts Receivable (AR), Payment Posting, Denial Management, and Insurance Follow-ups.

The ideal candidate should have a strong understanding of US healthcare billing practices, payer requirements, clearinghouses, medical coding guidelines, and RCM workflows, with the ability to identify billing issues, resolve claims, and support timely revenue collection.

Key Responsibilities

• Perform daily charge entry, claim generation, claim review, and timely submission through EDI and other applicable channels.
• Review and identify claim errors, rejections, and missing information before submission.
• Manage AR aging and proactively follow up on outstanding balances across 30+, 60+, 90+, and 120+ day buckets.
• Post ERAs and EOBs accurately, including deductibles, co-pays, co-insurance, contractual adjustments, and write-offs.
• Investigate claim denials and rejections, identify root causes, submit corrected claims, and prepare appeals where required.
• Conduct regular follow-ups with Medicare, Medicaid, and commercial payers such as BCBS, Aetna, Cigna, and Humana through phone calls and payer portals.
• Monitor and resolve clearinghouse rejections through platforms such as Availity, Waystar, Change Healthcare, or similar systems.
• Verify patient eligibility, insurance benefits, and prior authorization requirements to help prevent front-end billing issues.W
• Process patient statements and respond professionally to patient billing inquiries in accordance with practice policies.
• Maintain accurate billing records while following HIPAA, patient privacy, and applicable healthcare regulations.
• Apply knowledge of CPT, ICD-10, HCPCS, modifiers, NCCI edits, and payer-specific billing guidelines when reviewing and resolving claims.
• Prepare daily, weekly, and monthly reports covering key RCM metrics, collections, AR trends, denial rates, and overall performance.
• Coordinate with healthcare providers, clinical teams, and US clients to resolve documentation and billing-related issues.
• Identify workflow gaps and recommend improvements to reduce denials, improve collections, and increase overall RCM efficiency.

Qualifications & Requirements

• 4–5 years of hands-on experience in US RCM, medical billing, AR follow-up, payment posting, and denial management.
• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field is preferred.
• Strong understanding of the complete US medical billing and RCM lifecycle.
• Hands-on experience with EHR/Practice Management systems such as eClinicalWorks, Kareo, athenahealth, AdvancedMD, Practice Fusion, or similar platforms.
• Familiarity with clearinghouses including Availity, Waystar, Change Healthcare, and insurance payer portals.
• Strong knowledge of CPT, ICD-10, HCPCS, modifier guidelines, NCCI edits, and payer-specific requirements.
• Proficiency in MS Excel, including Pivot Tables, VLOOKUP, and basic reporting/data analysis.
• Excellent written and verbal English communication skills with professional phone etiquette for communicating with US insurance representatives and clients.
• Strong analytical and problem-solving skills with the ability to investigate complex denials and billing discrepancies.
• Strong attention to detail, organizational skills, and ability to manage multiple accounts and priorities.
• Ability to work independently while meeting assigned productivity, quality, and collection targets

Pay: Rs80,000.00 - Rs120,000.00 per month

Work Location: In person