We are seeking an experienced and strategic RCM Manager with hands-on expertise in Candid Health software to oversee end-to-end medical billing operations, claim processing, and denial resolution workflows. In this role, you will lead the revenue cycle team, leveraging Candid Health’s modern platform to optimize claim submissions, troubleshoot payer rejections, and maximize net collections for our healthcare operations.
REQUIREMENTS & QUALIFICATIONS
- Direct System Experience: Proven leadership experience in US healthcare revenue cycle management, with mandatory, hands-on proficiency in Candid Health billing software.
- Payer & Billing Knowledge: Deep understanding of US healthcare reimbursement models, Medicare/ Medicaid regulations, private commercial insurance policies, and CMS-1500 claim guidelines.
- Medical Coding Standards: Solid knowledge of standard medical code sets (ICD-10-CM, CPT, HCPCS) and clinical documentation requirements.
- Technical & Analytical Aptitude: Strong proficiency in data analysis using Microsoft Excel (Pivot tables, VLOOKUP/XLOOKUP) to isolate and rectify systemic billing errors.
