RCM Specialist

Job description

Gulf Coast RCM and Billing Solutions is a high-growth startup on a mission and we are on a mission to redefine "Concierge-Level" high-performance RCM and clinical solutions. We help specialized medical practices across the US build elite remote teams for Scribing, Coding, Billing, and Front-Office operations.

Our mission is centered on our Clients, our People, and Operational Excellence, ensuring that every interaction adds value to the healthcare ecosystem.

Distinguished by our pursuit of "Concierge-Level" standards, Gulf Coast excels in:

• Scale-Up Culture: We are a lean, agile startup looking to scale rapidly. You won’t just be a number here; you will be a foundational member of our core team.
• Expert Recruitment: We selectively hire only the top industry professionals; established experts who are already HIPAA-certified and highly experienced.
• Peak Performance: We provide an environment built for elite talent to excel. We don't do basic training; we focus on high-level execution and operational precision.
• Secure Infrastructure: We provide a premium, high-security workspace equipped with cutting-edge technology and a professional corporate culture.

Join us at the ground floor of a company designed to lead. Experience unparalleled professional growth with Gulf Coast RCM and Billing Solutions; where we are redefining the essence of offshore healthcare management.

If you are a HIPAA-certified professional who thrives in a fast-paced, high-standard environment, we want to build the future of RCM with you.

Job Summary

We are seeking a high-precision RCM Specialist to lead the patient intake and eligibility process for a US-based medical practice. You will be responsible for the "Pre-Service Gate," ensuring that every scheduled patient has active insurance coverage and all necessary prior authorizations. Your work is the foundation of a clean revenue cycle; your accuracy directly prevents claim denials and ensures the clinic is paid for the care it provides.

Key Responsibilities

• 100% Eligibility Verification: Verify insurance active/inactive status for all patients 24-48 hours prior to their appointment.
• Prior Authorizations: Initiate and track authorization requests for surgeries, specialized tests, and high-value procedures.
• Referral Management: Map and track incoming referrals from external physicians; ensure all clinical documentation required for the referral is present in the EHR.
• Patient Communication: Contact US-based patients to resolve insurance discrepancies, update demographic information, and explain out-of-pocket responsibilities (co-pays/deductibles).
• Provider Scheduling: Optimize physician calendars by ensuring "Green Light" status for all upcoming appointments.
• Quality Audit: Maintain a zero-backlog "Pre-Service" dashboard, ensuring no patient is seen without confirmed coverage.

Required Qualifications

• Experience: 3–6 years in US Healthcare Front-End operations (Patient Access, Eligibility, or Authorizations).
• Knowledge: Deep understanding of US insurance types (Medicare, Medicaid, PPO, HMO, and Commercial Payers).
• Portals: Proficiency in using payer portals (e.g., Availity, Waystar, UnitedHealthcare, BlueCross) and EHR scheduling modules (e.g., AthenaOne, eCW).
• Communication: Clear, neutral English speaking skills for outbound coordination with US insurance reps and patients.
• Analytical Skills: Ability to troubleshoot "Ineligible" status and find alternate coverage or secondary insurance.

Technical & Security Requirements

• Must follow strict HIPAA guidelines and a "Clean Desk Policy."
• Experienced in working within a Thin Client/VDI environment.
• Ability to handle high-volume outbound calling with Whisper/Barge coaching support.

Job Types: Full-time, Permanent

Pay: ₹35,000.00 - ₹50,000.00 per month

Benefits

• Health insurance
• Provident Fund

Work Location: In person