About OptiClaim
OptiClaim is a healthcare Revenue Cycle Management (RCM) company specializing in accounts receivable management, denial resolution, and claims optimization for hospitals and healthcare providers. We partner with clients to improve collections, reduce denials, and streamline billing operations through accurate, compliant, and efficient revenue cycle processes.
Job Title: Process Executive – AR – Revenue Cycle Management (RCM)
Department: Revenue Cycle Management (RCM) – Accounts Receivable (AR)
Reports To: Team Lead / Supervisor – RCM
Employment Type: Full-Time (Remote)
Work Mode: Online / Work From Home — 5:30 PM IST to 1:30 AM IST
Job Summary
The Process Executive – AR is responsible for managing and optimizing accounts receivable processes within the revenue cycle, including patient status review, charge accuracy, and claims resolution. This role involves reviewing and following up on outstanding insurance claims, resolving denials, and ensuring timely collections in alignment with payer policies and client guidelines. The Process Executive ensures billing accuracy and compliance across Inpatient, Observation, and other patient account types — working closely with coding, billing, payers, and clinical teams to resolve discrepancies, support client satisfaction, and drive revenue recovery.
Key Responsibilities
- Review patient accounts daily to identify and resolve status discrepancies, escalating cases to the appropriate team when needed.
- Understand rejections, denials, and failed claims, with knowledge of payer logic and reimbursements.
- Monitor observation and extended-stay patients, tracking cases that require authorization review or a status decision.
- Verify and correct room & board and other charge discrepancies, and initiate claim rebilling where required.
- Review aged accounts receivable (AR) to identify denial trends, underpayments, and root causes, and document findings.
- Perform regular AR audits to identify trends and drive process improvements.
- Track and report on length-of-stay (LOS) and related billing metrics on a regular basis.
- Identify unbilled or pending claims and coordinate with coding, billing, and medical records teams to resolve holds.
- Analyze claim status and update account notes to keep records accurate and current.
- Maintain accurate, up-to-date tracking sheets and reports to support team and leadership reviews.
- Follow up on outstanding claims with payers and internal stakeholders to ensure timely resolution and collections in line with payer policies and client guidelines.
- Respond to client inquiries and support issue resolution, maintaining clear and proactive communication.
- Escalate unresolved issues promptly and keep the reporting manager informed of task status and priorities.
- Support process improvement efforts by flagging recurring issues or gaps in documentation.
- Adhere to compliance standards and performance targets to support client satisfaction and revenue recovery.
Required Skills & Qualifications
- 3–5 years of experience in Revenue Cycle Management, medical billing, or healthcare accounts receivable.
- Working knowledge of patient status types (Inpatient/Observation), charge review, and claims processes.
- Strong analytical skills to review claims, identify root causes of denials and underpayments, and recommend effective solutions.
- Comfortable working with hospital billing systems and Excel/Google Sheets for tracking and reporting.
- Strong knowledge of Excel formulas, functions, and simple data visualization using pivot tables, charts, etc.
- Customer support and customer service skills to handle client interactions, address concerns, and provide clear, timely updates.
- Excellent written and verbal communication skills to interact with payers, clients, and team members.
- Strong focus on customer satisfaction, ensuring service delivery aligns with client expectations and quality standards.
- Familiarity with insurance payer rules, EOBs (Explanation of Benefits), and RCM software or practice management systems.
- Strong attention to detail and accuracy when handling account-level data.
- Ability to work independently in a remote environment, manage time effectively, and meet performance metrics and deadlines.
- Relevant education in healthcare administration, finance, or a related field, or equivalent experience in AR and RCM operations.
Preferred Systems Exposure
- Hospital/EHR systems such as Cerner or similar
- Billing platforms such as STAR, 3M, or ClaimSource
- Reporting tools such as MIDAS or similar
Key Interactions
- Coordinates with Coding, Billing, Medical Records, and Payer teams on claim discrepancies, denials, and holds.
- Interacts directly with clients to respond to inquiries and support issue resolution.
- Escalates patient status and account concerns to designated reviewers.
- Reports task completion and priorities to the Team Lead/Supervisor.
Interested candidates can apply directly or send their resume to [email protected]