The Senior RCM Expert is responsible for handling complex RCM issues, technical escalations, claim and denial resolution, and root-cause analysis. The role provides advanced process guidance to team members, supports quality and training initiatives, and contributes to operational stability, denial reduction, AR improvement, and overall process efficiency.

Key Responsibilities:

• Resolve complex RCM issues, exceptions, denials, claim corrections, payment concerns, and account-level barriers.
• Handle technical escalations and provide advanced process guidance to team members and operational leads.
• Analyze recurring errors, denial patterns, payer issues, workflow gaps, and process failures to identify root causes.
• Support error correction, quality improvement, rework reduction, and preventive actions.
• Provide guidance on SOPs, payer rules, client instructions, documentation requirements, and workflow processes.
• Support refresher training, floor clarifications, buddy support, and knowledge sharing with junior resources.
• Monitor and support improvements in productivity, quality, TAT, backlog, denials, AR, billing, posting, and collections.
• Identify and recommend process improvements, workflow corrections, and control measures based on operational findings.
• Maintain accurate issue documentation, trackers, account notes, and process observations.
• Escalate unresolved technical, payer, client, system, or compliance issues to the appropriate Team Lead or management.