Purpose:

• The Revenue Cycle Management Specialist ensures accurate and timely processing of medical claims by verifying eligibility, identifying discrepancies, and supporting decision-making in line with company procedures. The role helps improve operational efficiency, prevents errors or fraud, and supports internal and external stakeholders to maintain smooth and effective revenue cycle operations.

Duties and Responsibilities:

• Manage routine daily claims administration work.
• Evaluating, analyze and assess claims with regards to eligibility.
• Increasing efficiency, minimizing errors and administration time.
• Identify and investigate claims for possible abuse and fraud.
• Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., use of all documented resources).
• Comprehend with complex workflows and come up with a customer-centric solution within reasons.
• Escalate unresolved claims complaints and high costs claims to the claim’s supervisor for guidance
• Over-viewing surgeries CPT codes and post operative reports before surgeries claims submission
• Establish relationships with internal and external customers.
• Be resilient and adaptable to changes in priorities according to business needs.
• Accountable for reporting operational and medical analysis to enhance business performance and provide needed trainings accordingly

Job Requirements:

Education:

• Bachelor's degree in medicine/ Pharmacy major from reputable university.

Requirements:

• 0-1 years relevant industry experience
• Very good command of English language.
• Advanced knowledge of Microsoft (Word, PowerPoint, and Excel).
• Ability to work well with all levels of internal management and staff, as well as outside clients and users.
• Handling claim verification till decision making as per company procedure and authority matrix.
• Communicate with internal and external stakeholders to collect all required claims documentation and verifications.
• Reporting and administrative tasks related to claims management department.

Additional Needs:

• Analytical skills.
• Technical skills.
• Oral and written communication skills.
• Understanding of medical terminology.
• Ability to maintain accuracy and production standards.

Work Conditions:

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