Medicare Revenue Cycle Specialist

Job Summary

A company is looking for a Revenue Cycle Management Specialist - Care Navigation (Medicare CHI/PIN).

Key Responsibilities

• Own end-to-end revenue cycle management for Medicare CHI and PIN claims, ensuring timely and compliant submissions
• Audit charge capture against clinical documentation and manage claims denials and appeals
• Collaborate with care navigators and clinicians to close documentation gaps and report key performance indicators

Required Qualifications

• 2 to 5 years of hands-on US medical billing/revenue cycle experience, preferably in an Indian healthcare BPO or US-RCM offshore captive
• Direct experience billing Medicare Part B claims is mandatory
• Hands-on experience with CHI and PIN code families, including relevant Medicare G-codes
• Strong knowledge of care-coordination codes and their interactions with CHI/PIN
• Familiarity with EHR/PMS systems and US clearinghouses