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RCM QA Specialist – Adjustments, Refunds
ResMedRCM QA Specialist handling adjustments and refunds within revenue cycle management for ResMed. Ensuring accuracy in billing and compliance with procedures while participating in quality control initiatives.
About the role
Key responsibilities & impact- 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
Requirements
What you’ll need- 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
- Bachelor's degree preferred, with 2 years of related experience
- Proficiency in using Brightree software is highly preferred.
Benefits
Comp & perks- Professional development opportunities
- Health insurance
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
AR follow-updenial managementadjustments processingrefund processingrevenue cycle managementpayer managementcoding regulationsbilling regulationsreimbursement guidelinesquality control
Soft Skills
communication skillsanalytical skillsproblem-solving skillsattention to detailorganizational skillsteamworkindependenceprocess improvementtime managementauditing