RCM Domain Expert

Overview

We are seeking a Revenue Cycle Management (RCM) Domain Expert with in-depth knowledge of local healthcare regulations, payer requirements, and medical claims workflows. This role will be responsible for ensuring the system’s medical rules, claims logic, and insurance workflows are accurate, up-to-date, and aligned with market needs.

• Act as the subject matter expert for RCM processes, claims lifecycle, and payer-specific rules.
• Maintain and validate medical and insurance rules inside the platform to ensure compliance.
• Monitor market changes, including regulator updates, payer table of benefits, and coding standards.
• Collaborate with engineering and AI teams to ensure accurate automation of claims workflows.
• Define acceptance criteria for RCM-related features and validate implementation.
• Support user acceptance testing (UAT) for RCM and insurance modules.
• Train internal teams on RCM best practices, regulations, and system updates.

• Bachelor’s in Healthcare Administration, Business, or related field.
• 5+ years of hands‑on experience in RCM operations or healthcare insurance.
• Strong understanding of local payer requirements and regulatory frameworks.
• Familiarity with ICD-10, CPT, HCPCS, and eclaims standards.
• Experience in process optimization and RCM automation tools.
• Excellent analytical and communication skills.