Senior Analyst RCM | Optum Hyderabad, Telangana

Job Description

Summary

Optum is hiring a Senior Analyst RCM in Hyderabad, Telangana to optimize the US Healthcare Revenue Cycle Management (RCM) process. This role focuses on claims management, denial resolution, AR follow-ups, process optimization, and revenue recovery. The ideal candidate will leverage their expertise in medical billing, coding (CPT, ICD-10, HCPCS), payer contracts, and EHR systems to improve cash flow, reduce bad debt, and enhance operational efficiency. This position is ideal for professionals with experience in RCM software, healthcare analytics, and compliance within the US healthcare ecosystem.

Job Details at a Glance

Primary Responsibilities

• Claims Management: Investigate and resolve denied, aged, or complex medical claims to maximize reimbursements.
• Denial Analysis & Resolution: Identify patterns in claim denials using CARC & RARC codes, perform root cause analysis, and implement corrective actions.
• AR Follow-up: Engage with insurance providers and commercial payers to resolve outstanding balances.
• Payer Guidelines Management: Review and share updates on payer behavior and provide actionable insights to FMB teams.
• Billing & Coding Correlation: Analyze and ensure proper coding and billing for acute and ambulatory claims.
• Process Optimization: Recommend workflow improvements to enhance revenue cycle performance.
• Compliance & Documentation: Maintain adherence to HIPAA, payer policies, and internal guidelines while documenting all actions accurately.
• Collaboration: Work with Front, Middle, and Back-office teams to streamline operational workflows.
• Training & Knowledge Sharing: Mentor and coach team members, sharing best practices and process insights.
• Root Cause Analysis: Conduct deep dives, audits, and process reviews to recommend corrective and preventive actions.
• Financial KPI Management: Track and analyze KPIs such as collection goals, denial %, AR days, rejections %, and provider bad debt.

Required Skills & Qualifications

• Bachelor’s degree in Finance, Healthcare Administration, Business, or related field.
• 3+ years of experience in Revenue Cycle Management with leadership or mentorship experience.
• Expertise in AR follow-up, appeals, dispute resolution, and claims adjudication.
• Strong knowledge of US healthcare RCM, medical billing, coding (CPT, ICD-10, HCPCS), and payer reimbursement methodologies.
• Proficiency with RCM tools and EHR software (e.g., EPIC, eClinicalWorks, Athenahealth).
• Solid understanding of HIPAA, compliance, and regulatory requirements.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong communication, leadership, and team management abilities.

Preferred Qualifications

• Experience with process improvement methodologies such as Lean or Six Sigma.
• Advanced skills in Excel, SQL, Power BI, or Tableau for reporting and analytics.
• Knowledge of revenue cycle performance KPIs and analytics.
• Experience performing Root Cause Analysis (RCA) and process audits.

Why Join Optum

• Drive impactful healthcare financial solutions across the US healthcare system.
• Work with cross-functional teams to optimize revenue cycle processes and enhance patient care.
• Collaborate in a culture guided by inclusion, professional development, and career growth.
• Gain exposure to industry-leading RCM tools, analytics, and reporting systems.

Apply Now

Take the next step in your healthcare finance career as a Senior Analyst RCM at Optum Hyderabad.

👉 Apply Now at Optum Careers