RCM Manager / Director of Operations (US-based)

Duration: 2026-03-16 - 2026-04-16
Monthly Salary: Rs. 40,000.00 - Rs. 60,000.00
Job position: RCM Manager / Director of Operations (US-based)

Client of CPHR Services

Pune, India
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Job description

Key Responsibilities

Charge Entry: Perform accurate charge entry based on provider documentation,
applying correct ICD-10-CM, CPT, and HCPCS Level II codes specific to urgent care
encounters

Claim Submission: Submit clean claims to commercial insurers, Medicare, Medicaid
(including NY Medicaid), and managed care organizations via clearinghouse platforms
(Waystar and others)

Claim Monitoring: Monitor claim statuses through the clearinghouse and payer portals;
resolve edits and rejections prior to and after submission

AR Follow-Up: Conduct proactive accounts receivable (AR) follow-up with insurance
companies via phone, portal, and written correspondence

Denial Management: Manage and work denial queues — analyze denial reason codes
(CO, PR, OA), appeal inappropriate denials, and track appeal outcomes

Payment Posting: Post payments (ERAs/EOBs) accurately, reconcile remittance
advices, and escalate discrepancies

Eligibility Verification: Perform eligibility and benefits verification for various payers
prior to or at time of claim submission when needed

Compliance: Ensure compliance with HIPAA, payer-specific guidelines, and CMS billing
regulations

Reporting: Generate and review aging reports to identify trends and escalate high-
priority accounts

Collaborate with the US-based billing and clinical teams to resolve coding and
documentation issues

Maintain thorough notes and documentation within the Practice Management System
(PMS) on all account activity

Keep up-to-date with payer policy changes, urgent care billing guidelines, and CPT
coding updates

Required Qualifications

Minimum 3–5 years of hands-on experience in US healthcare Revenue Cycle
Management (RCM)

Demonstrated experience specifically in urgent care, emergency medicine, or
ambulatory/walk-in clinic billing

Proficiency in ICD-10-CM, CPT (E/M codes, procedure codes, modifier usage), and
HCPCS coding relevant to urgent care

Direct experience working with Waystar (formerly Zirmed/Navicure) or comparable
clearinghouses (e.g., Availity, Change Healthcare/Optum)

Familiarity with major US payers including Medicare, Medicaid (NY preferred), BCBS,
UnitedHealthcare, Aetna, Cigna, and regional managed care plans

Experience using Practice Management Systems (e.g., AdvancedMD, Kareo,
athenahealth, eClinicalWorks, or similar)

Strong understanding of claim lifecycle: eligibility → charge entry → claim scrubbing →
submission → payment posting → denial management → appeals

Solid working knowledge of denial codes, remark codes, and appeals processes

Excellent written and verbal English communication skills for coordination with US-
based team members

Strong attention to detail, analytical thinking, and ability to prioritize workload in a fast-
paced environment

Must be comfortable working US Eastern Time Zone hours

Preferred Qualifications

AAPC or AHIMA certification (CPC, CPC-A, CBCS, or equivalent) is a strong plus
Prior experience working with offshore RCM delivery teams (e.g., with companies such
as Healthquist, Access Healthcare, 4D Global, MBW RCM, Clarus RCM, or similar)
Familiarity with New York State Medicaid billing requirements and managed care billing
Experience with Workers’ Compensation or No-Fault/Auto billing (common in NY
urgent care)
Exposure to CDI (Clinical Documentation Improvement) practices or charge capture
audits
Knowledge of CMS NCCI edits and modifier application (e.g., -25, -57, -59, -76)

Technical Skills
Waystar clearinghouse (claim submission, edit resolution, ERA retrieval)
Practice Management Software (any major platform)
Microsoft Excel / Google Sheets (pivot tables, VLOOKUP, aging analysis)

Payer portals (NPPES, Medicare PECOS, state Medicaid portals, commercial payer
portals)
Strong typing speed and data entry accuracy

What We Offer
Competitive compensation aligned with Indian RCM industry standards
Stable, long-term engagement with a growing urgent care group
Collaborative team environment with US-based leadership and direct client exposure
Opportunity for career advancement as we expand our operations
Work-from-home flexibility (with reliable internet and a professional remote setup
required)

How to Apply
Interested candidates should submit:
Updated CV/Resume highlighting urgent care billing experience
Brief cover letter describing your experience with Waystar or similar clearinghouses and
the types of payers you’ve worked with
 Any relevant certifications (AAPC/AHIMA)

Skill Required

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Job Detail

Location
pune
Company
Client of CPHR Services
Type
Full time
Positions
201
Quantity to be recruited
1
Seniority
...
degree
...
Apply Before
16/04/2026