Job Title: RCM - Blended (Healthcare Revenue Cycle Specialist)
Skills: 2–4 years in RCM (physician groups, hospital billing, or healthcare BPO) processing claims & verify insurance coverage.
Experience: Exposure to CPT, EMR, A/R Follow-up, resolve denials.
Location: Muntinlupa, Philippines
We at Coforge are hiring Healthcare Revenue Cycle Specialist with the following skillset:
- Knowledge of CPT, ICD-10, and POS unites.
- Ability to review and validate charges, units, documentation, and batch charges.
- Skills in denial management, corrected claims, appeals, and reconsiderations.
- Experience updating EMR/PM/HIS systems
- Maintaining clean documentation for QA/audits
- Ability to maintain detailed notes and logs for audits Responsibilities:
- Charge Capture for Physician & Hospital
- Review documentation, charge tickets, and hospital batch charges for accuracy (CPT, POS, units). - Coordinate with providers, coders, and clinical staff to resolve documentation issues.
- A/R Follow-Up
- Conduct payer follow-ups via portals, calls, and clearinghouse tools.
- Resolve denials, submit corrected claims, appeals, and reconsiderations.
- Eligibility & Benefits Verification - Verify insurance coverage for diverse service types.
- Confirm co-pays, deductibles, coinsurance, OOP limits, and exclusions.
- Identify pre-auth, referral, and pre-cert requirements.
- Ensure accurate data entry in EMR/PM/HIS systems.
- Cross-Functional Coordination
- Collaborate with physicians, practice managers, coders,
- HIM, patient access, utilization review, and case management.
- Compliance & Documentation
- Follow HIPAA, CMS, and payer guidelines.
- Maintain accurate notes, logs, and claim documentation.
- Participate in audits, QA reviews, and ongoing RCM training (CPT/Medicare updates)
