RCM QA Specialist - Adjustments / Refunds at ResMed

Chennai, tamil nadu, India -

Full Time

Start Date

Immediate

Expiry Date

20 Sep, 26

Salary

0.0

Posted On

22 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

AR Follow-up, Denial Management, Revenue Cycle Management, Refund Processing, Payer Contract Analysis, Audit Compliance, Quality Control, Brightree Software, Medical Billing, Analytical Problem Solving, Communication Skills, Organizational Skills

Industry

Medical Equipment Manufacturing

Description

Let’s talk about Responsibilities Very good understanding of AR follow-up and denial management, to resolve outstanding issues and minimize AR aging processing appropriate write offs and adjustments. Accurately and timely adjustments and refund processing, into the billing system. Conduct thorough adjustments & refund reviews, ensuring accuracy and adherence to established procedures. Review accounts and resolve discrepancies in adjustments & refunds to ensure accurate financial records. Maintain a comprehensive understanding of US payer contracts, EOB/ERA codes, and adjustments to accurately review payments, credits and adjustments. Stay updated with changes in reimbursement policies, payer contracts, and industry regulations related to insurance write offs, adjustments and refund specific rules. Maintain documentation of adjustments and refund processes, procedures, and payer-specific guidelines. Participate in team meetings and provide input for process improvement initiatives. Attention to details for reviewing and following the relevant SOPs and instructions for adjustments and refund processes Assist with internal and external audits, ensuring compliance with regulatory and contractual obligations. Participate in quality control activities, conducting audits and providing recommendations for process improvements. Let’s talk about Qualifications and Experience Required: 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, with the ability to effectively communicate with internal teams, clients, and payers. Detail-oriented with exceptional analytical and problem-solving skills. Previous experience as an auditor and quality control specialist is preferred, but not mandatory. 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. Preferred: Bachelor’s degree. 2 years of related experience. Proficiency in using Brightree software is highly preferred. Developing professional expertise, applies company policies and procedures to resolve a variety of issues. Joining us is more than saying “yes” to making the world a healthier place. It’s discovering a career that’s challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individual expression in the workplace and thrive on the innovative ideas this generates. If this sounds like the workplace for you, apply now! We commit to respond to every applicant. Resmed (NYSE:RMD, ASX: RMD) creates life-changing health technologies that people love. We’re relentlessly committed to pioneering innovative technology to empower millions of people in more than 140 countries to live happier, healthier lives. Our AI-powered digital health solutions, cloud-connected devices and intelligent software make home healthcare more personalized, accessible and effective. Ultimately, Resmed envisions a world where every person can achieve their full potential through better sleep and breathing, with care delivered in their own home. Learn more about how we’re redefining sleep health at Resmed.com and follow @Resmed.

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Responsibilities

The specialist is responsible for managing AR follow-ups, denial management, and the accurate processing of adjustments and refunds. They must ensure financial record accuracy by adhering to US payer contracts and conducting thorough quality audits.