Reconciliation Specialist (US Healthcare)

This role is for one of the Weekday's clients

Salary range: Rs 100000 - Rs 400000 (ie INR 1-4 LPA)

Min Experience: 2 years

Location: Bengaluru

JobType: full-time

We are seeking a detail-oriented and analytical Reconciliation Specialist (Recon) with a strong background in US Healthcare to join our dynamic team. The ideal candidate will be responsible for ensuring accuracy and consistency in financial and billing data by reconciling accounts, identifying discrepancies, and supporting revenue cycle processes. This role requires a solid understanding of medical billing workflows, coding standards, and healthcare compliance regulations.

Requirements:
Key Responsibilities

• Perform end-to-end reconciliation of healthcare accounts, including billing, payments, adjustments, and denials.
• Analyze and resolve discrepancies between payer reports, internal systems, and financial records.
• Work closely with billing, coding, and accounts receivable teams to ensure accurate claim processing and reimbursement.
• Review Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), and payer statements for reconciliation accuracy.
• Identify trends in payment variances, denials, and underpayments, and escalate issues when required.
• Maintain reconciliation logs, reports, and documentation for audit and compliance purposes.
• Ensure adherence to US healthcare regulations, HIPAA guidelines, and organizational policies.
• Support process improvement initiatives to enhance reconciliation efficiency and reduce revenue leakage.

Required Qualifications

• Educational Background: Bachelor’s degree in Life Sciences, Pharmacy, Nursing, or any Medical-related field (mandatory).
• Experience: Minimum 2+ years of experience in US Healthcare domain.
• Overall experience ranging between 2 to 8 years in reconciliation, revenue cycle management, or related functions.
• Strong exposure to healthcare billing processes, payer systems, and claims lifecycle.

Additional Acceptable Experience

• 2–3 years of hands-on experience in Medical Coding or Medical Transcription will also be considered relevant.
• Familiarity with coding systems such as ICD-10, CPT, and HCPCS is a plus.

Key Skills & Competencies

• In-depth knowledge of US Healthcare systems, insurance workflows, and reimbursement methodologies.
• Proficiency in Medical Coding and understanding of clinical documentation.
• Strong analytical and problem-solving skills with high attention to detail.
• Ability to interpret EOBs, ERAs, and payer-specific guidelines.
• Experience working with healthcare software, billing systems, and Excel for data analysis.
• Excellent communication and collaboration skills to work with cross-functional teams.
• Ability to manage multiple tasks, meet deadlines, and work in a fast-paced environment.

Preferred Attributes

• Experience in Revenue Cycle Management (RCM) processes.
• Knowledge of denial management and AR follow-ups.
• Familiarity with automation tools and reconciliation systems.
• Strong organizational skills with a focus on accuracy and compliance.