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Job Description – RCM Specialist (US Healthcare)

Location: Chennai, India
Company: CogniAI Advanced Research Solutions Pvt. Ltd.
Department: Healthcare AI Solutions – CogniRCM
Employment Type: Full-Time
Shift: US Shift (Evening/Night IST)

About CogniAI

CogniAI is an AI-first enterprise modernization company focused on Healthcare, Government, and Enterprise AI solutions. Our healthcare platform, CogniRCM, leverages Agentic AI, intelligent automation, and analytics to transform Revenue Cycle Management for U.S. healthcare providers. We are building the next generation of AI-assisted RCM operations from our Chennai Global Capability Center (GCC).

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Position Summary

We are seeking a highly motivated Revenue Cycle Management (RCM) Specialist with experience in the U.S. healthcare revenue cycle. The candidate will support end-to-end medical billing operations while working alongside AI engineers to improve automation through the CogniRCM platform.

This role combines traditional RCM expertise with AI-assisted workflows to improve collections, reduce denials, and enhance operational efficiency.

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Key Responsibilities

Patient Access

Verify patient eligibility and insurance benefits.
Validate demographics and insurance information.
Obtain prior authorizations when required.
Ensure complete documentation before claim submission.

Medical Billing

Review charge capture for accuracy.
Submit professional (CMS-1500) and institutional (UB-04) claims.
Monitor electronic claim acceptance.
Resolve claim rejections promptly.

Payment Posting

Post ERA/EOB payments accurately.
Process patient payments.
Reconcile payment discrepancies.
Balance daily transactions.

Accounts Receivable

Perform insurance follow-up.
Contact payers regarding outstanding claims.
Reduce aging accounts.
Escalate complex reimbursement issues.

Denial Management

Analyze denial root causes.
Prepare and submit appeals.
Correct coding or billing errors.
Track denial trends and recommend process improvements.

Compliance

Follow HIPAA regulations.
Maintain payer compliance.
Ensure billing accuracy.
Protect confidential patient information.

AI-Assisted Operations

Work with CogniRCM AI recommendations.
Validate AI-generated coding and billing suggestions.
Provide feedback to improve AI models.
Identify automation opportunities.

Reporting

Monitor KPIs including:
First Pass Claim Rate
Clean Claim Rate
Days in AR
Denial Rate
Collection Rate
Net Collection %
Prepare operational reports for management.

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Required Qualifications

Bachelor’s degree in Life Sciences, Healthcare Administration, Commerce, or related field.
2–5 years of experience in U.S. Healthcare Revenue Cycle Management.
Knowledge of:
Medical Billing
Claims Processing
Accounts Receivable
Denial Management
Payment Posting
Insurance Verification
Understanding of:
CPT
ICD-10-CM
HCPCS
CMS guidelines
Medicare
Medicaid
Commercial Insurance
Experience using EMR/EHR and medical billing software.
Strong analytical and communication skills.
Excellent attention to detail.

Healthcare RCM spans the complete financial workflow from patient registration through claims, reimbursement, collections, and denial management.

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Preferred Qualifications

CPC, CCS, CRC, or RCMS certification.
Experience with specialties such as:
Neurology
Pain Management
Family Medicine
Internal Medicine
Orthopedics
Cardiology
Experience with clearinghouses such as Waystar, Availity, Office Ally, or Change Healthcare.
Familiarity with Epic, Athenahealth, eClinicalWorks, NextGen, Kareo, or AdvancedMD.
Exposure to AI-assisted coding or healthcare analytics is a plus.

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Technical Skills

U.S. Medical Billing
Medical Coding fundamentals
Insurance Verification
Claims Submission
ERA/EOB Posting
AR Follow-up
Appeals
Denial Management
Microsoft Excel
Reporting Dashboards
Healthcare Analytics

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Key Performance Indicators (KPIs)

≥95% Clean Claim Rate
≥98% Payment Posting Accuracy
Days in AR within organizational targets
Reduction in denial rate
Appeals submitted within SLA
Productivity targets achieved
Quality score ≥98%
Positive contribution to AI model improvements

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What We Offer

Competitive salary
Performance bonus
Health insurance
Career growth in AI-powered Healthcare Technology
Training on Agentic AI and CogniRCM platform
Opportunity to work with U.S. healthcare providers on cutting-edge AI solutions

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Why Join CogniAI?

At CogniAI, you won’t just process medical claims—you’ll help shape the future of healthcare operations. As part of our Chennai Global Capability Center, you’ll work with clinicians, AI engineers, and data scientists to build intelligent Revenue Cycle Management solutions that combine human expertise with AI to improve healthcare outcomes and financial performance.

Pay: ₹25,000.00 - ₹45,000.00 per month

Benefits:

• Health insurance
• Provident Fund

Work Location: In person