Job Title: RCM Blended
Skills: 2–4 years in RCM (physician groups, hospital billing, or healthcare BPO)
Experience: Exposure to A/R Follow-ups, Insurance Verification, Billing, Prior Authorization
Location: Muntinlupa, Philippines
We at Coforge are hiring RCM Blended Specialist (Healthcare Revenue Management) with the following skillset:
- Excellent verbal communication and active listening skills.
- Strong understanding of insurance in CPT, POS, units.
- Eligibility & Benefits Verification
- Resolve denials, submit corrected claims, appeals, and reconsiderations.
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).
