RCM - Recovery and Collections

Job Description: RCM – Recovery / Collections Specialist (Healthcare)

Department:

Recovery & Collections – Revenue Cycle Management (RCM)

Role Overview:

The Recovery / Collections Specialist is responsible for securing and recovering outstanding receivables from insurance payers and patients within the healthcare revenue cycle. This role focuses specifically on resolving unpaid balances, negotiating payments, and ensuring accurate documentation while maintaining compliance with healthcare guidelines.

Key Responsibilities

• Identify accounts with pending balances and recover outstanding dues from insurance payers and patients.

• Perform collection activities for aging accounts as per workflow.

• Validate recovered amounts against expected reimbursement using EOBs, ERAs, and payer data.

• Document all recovery attempts, payer responses, and outcomes accurately in the system.

• Provide daily/weekly updates on recovery amounts and performance metrics.

Required Skills & Competencies

• Strong understanding of US healthcare RCM (Recovery & Collections).

• Ability to analyze payment trends and reimbursement gaps.

• Effective communication and negotiation skills.

• Knowledge of EOBs, ERAs, and payer policies.

• Attention to detail and accuracy in documentation.

Educational Qualifications

Bachelor’s degree in Commerce, Life Sciences, Business Administration, or equivalent. RCM certification preferred.

Experience

1–2 years of experience specifically in Recovery / Collections within US Healthcare RCM.

Key Performance Indicators (KPIs)

• Monthly recovery amount achieved

• Shortfall resolution rate

• Collection efficiency

• Accuracy of documentation

• Account resolution turnaround time

PF, Gratuity, Mediclaim