RCM AR Specialist at Veradigm in Pune, Maharashtra, IN

• Work Location - Pune (Work from Office)

• Shift timings - (7:30 PM - 4:30 AM) IST​

• Essential Duties and Responsibilities

• Work assigned AR worklists/queues, prioritizing accounts by dollar value, aging bucket, and payer class.

• Contact insurance payers via phone, online portals, and written correspondence to determine claim status and resolve outstanding balances.

• Identify and resolve claim denials by analyzing CARC/RARC codes, determining root cause, and initiating appropriate corrective action (resubmission, appeal, or adjustment).

• Prepare and submit written appeals with supporting clinical documentation for denied or underpaid claims.

• Verify expected reimbursement against payer contracts and fee schedules, identifying and escalating underpayments.

• Document all follow-up activity thoroughly in the billing system with clear action notes and next steps.

• Identify and report denial trends, payer-specific issues, and systemic billing problems to the AR Team Leader.

• Collaborate with coding, charge entry, patient access, and managed care teams to resolve upstream issues impacting claim payment.

• Process insurance and patient refund requests as identified during AR review.

• Meet daily/weekly productivity targets for accounts worked and dollars resolved.

• Ensure compliance with HIPAA, CMS, timely filing requirements, and organizational policies.

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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