Revenue Cycle Management (RCM) Administrator – Resubmissions

Job Description

Denial Management & Appeals

• Review denied and underpaid insurance claims and initiate appropriate resubmissions and appeals.
• Investigate reimbursement discrepancies and contractual variances.
• Prepare clear, accurate, and evidence-based appeal submissions.
• Support the resolution of complex billing and reimbursement issues.

Documentation & Collaboration

• Work closely with Coding, Health Information Management, Finance, and Clinical teams to obtain supporting documentation for claims appeals.
• Coordinate with internal stakeholders to ensure efficient claims processing.
• Assist with medical coding and billing activities when required.

Revenue Integrity & Analytics

• Analyze denial trends, underpayments, and revenue leakage opportunities.
• Perform root cause analysis and recommend corrective actions.
• Generate reports and metrics to support performance improvement initiatives.
• Support revenue optimization through data-driven insights.

Process Improvement

• Collaborate with multidisciplinary teams to reduce recurring denials.
• Contribute to workflow enhancements and denial prevention strategies.
• Participate in special projects and continuous improvement initiatives within Revenue Cycle Management.

Compliance & Governance

• Ensure compliance with payer guidelines, healthcare regulations, and hospital policies.
• Maintain strict confidentiality of patient and organizational information.
• Support organizational objectives through adherence to quality and compliance standards.

Qualifications

:Educatio

• nBachelor’s Degree in Paramedical Sciences, Accounting, Healthcare Administration, or a related field
• .Professional Coding Certification from AHIMA or AAPC highly advantageou

sExperienc

• eMinimum 3 years of relevant experience, including at least 2 years in denial analysis and claims resubmission within a hospital or day surgery center
• .Experience with managed care contracts, reimbursement reconciliation, and contract rate analysis is highly desirable

.Skills & Competencie

• sStrong understanding of medical billing, coding, claims processing, and insurance reimbursement
• .Ability to read and interpret medical records and clinical documentation
• .Excellent analytical and problem-solving skills with experience in root cause analysis
• .Strong attention to detail and ability to identify denial trends
• .Proficiency in Microsoft Office applications, particularly Excel
• .Effective communication and stakeholder management skills
• .Ability to manage multiple priorities in a fast-paced healthcare environment
• .High level of professionalism, integrity, and confidentiality
• .Self-motivated with a continuous improvement mindset