Very good understanding of AR follow-up and denial management
Accurately and timely adjustments and refund processing
Conduct thorough adjustments & refund reviews
Review accounts and resolve discrepancies in adjustments & refunds
Maintain a comprehensive understanding of US payer contracts, EOB/ERA codes
Stay updated with changes in reimbursement policies and payer contracts
Maintain documentation of adjustments and refund processes
Participate in team meetings and provide input for process improvement initiatives
Assist with internal and external audits
Participate in quality control activities

2 years of hands-on experience in revenue cycle management within the DME/HME specialty
Strong knowledge and experience with AR follow-up and denial management processes
In-depth understanding of US payer management, including Medicare, Medicaid, and commercial insurance
Excellent written and verbal communication skills
Detail-oriented with exceptional analytical and problem-solving skills
Previous experience as an auditor and quality control specialist is preferred
Ability to work independently and in a team-oriented environment
Strong organizational skills with the ability to prioritize tasks and meet deadlines
Up-to-date knowledge of coding and billing regulations, reimbursement guidelines, and industry trends
Bachelor’s degree preferred.

RCM QA Specialist – Adjustments, Refunds

Key skills