01Overview
Job Description
Charge Entry and Eligibility Verification Executive (RCM)
Department: Revenue Cycle Management (RCM) Data Operations
Location: Chennai
Reports To: Data Team Lead / Operations Manager
Job Summary
The Data Entry Executive plays a critical role in ensuring the accuracy and completeness of patient and insurance information before claims are submitted. With approximately 85% of charge entry automated through the TrueRCM platform, this role focuses on validating system-generated data, performing demographic and insurance updates, verifying eligibility, identifying missing or incorrect payer information, and resolving exceptions that could impact clean claim submission.
The ideal candidate should possess strong knowledge of healthcare insurance, payer portals, Medicare and Medicaid guidelines, and revenue cycle workflows.
Key Responsibilities
Patient & Demographic Management
- Review and update patient demographic information accurately.
- Validate patient registration details before claim submission.
- Correct demographic discrepancies identified through system edits.
Insurance Verification & Updates
- Verify insurance eligibility through payer portals and clearinghouse tools.
- Update primary, secondary, and tertiary insurance information.
- Identify and update Medicare Advantage, Medicaid Managed Care (MCO), Commercial, and other insurance plans.
- Verify Medicare Secondary Payer (MSP) information and update records accordingly.
- Identify hospice enrollment that may impact claim billing.
- Research and identify insurance coverage when policy/member ID is unavailable using payer portals and available patient demographics.
- Review coordination of benefits (COB) and determine the correct payer sequence.
Charge & Coding Review
- Review automated charge entries for completeness and accuracy.
- Validate CPT codes against encounter documentation and identify discrepancies for escalation.
- Ensure claims meet payer-specific billing requirements before submission.
- Work with coding and billing teams to resolve charge-related exceptions.
Payer Knowledge
- Utilize payer portals to verify:
- Eligibility
- Member information
- Policy details
- Authorization requirements (when applicable)
- Understand payer-specific billing rules and insurance mapping.
Quality & Compliance
- Ensure compliance with HIPAA regulations and organizational policies.
- Maintain high accuracy while meeting daily productivity targets.
- Document findings and resolutions in the practice management system.
- Escalate complex issues requiring coding, credentialing, or client intervention.
Required Skills
- Good understanding of the US Healthcare Revenue Cycle.
- Knowledge of:
- Medicare
- Medicaid
- Medicaid Managed Care (MCO)
- Medicare Advantage Plans
- Commercial Insurance
- Medicare Secondary Payer (MSP)
- Coordination of Benefits (COB)
- Experience using payer portals and eligibility verification tools.
- Understanding of CPT codes and claim submission workflow.
- Strong analytical and problem-solving skills.
- Excellent attention to detail.
- Good communication and documentation skills.
- Ability to work in a fast-paced production environment.
Preferred Qualifications
- Graduate in any discipline.
- 13 years of experience in US Healthcare Revenue Cycle Management.
- Experience in Data Entry, Insurance Verification, Eligibility Verification, Charge Review, or Claims Preparation.
- Experience with EMR, Practice Management Systems, ClaimMD, Availity, Waystar, or similar payer portals is preferred.
Key Performance Indicators (KPIs)
- Demographic accuracy.
- Insurance update accuracy.
- Eligibility verification accuracy.
- Clean claim support rate.
- Productivity (accounts/encounters processed per day).
- Quality audit score.
- Turnaround time (TAT).
- Exception resolution within SLA.
At Rapid Care, technology automates approximately 85% of traditional charge entry activities, allowing our Data Operations team to focus on higher-value analytical work that directly improves clean claim rates, reduces denials, and accelerates revenue collection. Team members gain extensive exposure to US healthcare insurance, payer rules, eligibility verification, and advanced revenue cycle processes, creating robust opportunities for career growth within Revenue Cycle Management. .
