KPMG - RCM and medical Profiles

Job Profile: Sr. Medical Billing Specialist

Department: Revenue Cycle Management

Location: Hyderabad

Employment type:

• ☐ Full-Time
• ☒ Regular
• ☐ Part-Time
• ☐ Contingent
• ☐ On-Call

Job Role

The Sr. Medical Billing Specialist will serve as a subject matter expert (SME) in oncology billing workflows, while also mentoring new hires and driving process excellence. The role demands precision, compliance awareness, and the ability to navigate complex payer rules across Medicare, Medicaid, and commercial plans. The specialist will act as a bridge between India Ops and US Patient Accounting teams, ensuring alignment, audit-readiness, and operational continuity. The Sr. Medical Billing Specialist will be knowledgeable in their respective team roles and serve as the main point of contact for new employees. They will be a liaison between Patient Accounting staff, management, and director to ensure effective communication.

Key Responsibilities

• Perform accurate and timely charge entry, claim creation, and submission for oncology services including chemotherapy, infusion, radiation, and consults.
• Validate CPT/HCPCS codes, modifiers, and ICD-10 diagnosis mapping based on clinical documentation.
• Resolve billing edits, payer rejections, and documentation gaps in coordination with coding and clinical teams.
• Ensure compliance with protocols, payer-specific rules, and state/federal regulations.
• Maintain daily productivity and accuracy benchmarks; escalate anomalies proactively.
• Support month-end close, audit preparation.
• Willingness and desire to assist in the orientation of new hires.
• Oversees the orientation of new hires during determined orientation period.
• Monitors the orientation checklist so that outcomes are met within the appropriate time frame.
• Communicates with members of management regarding new hire progress.
• Collaborate with manager and trainer at 15, 45 and 90-day evaluations.
• Provides expertise in skills and knowledge.
• Follows and understands all policies and procedures ensuring best practice.
• Collaborate with the training team on assessed education needs to develop organized, proficient, and quality focused education program.
• Works in collaboration with all departments to ensure organizational goals are met.
• Attend training session to develop skill set for adult learning training strategies.
• Completes assigned work as Medical Billing Specialist in addition to assigned Preceptor training responsibilities.
• Fulfills daily responsibilities as Medical Billing Specialist when individual preceptor assignment is not required.
• Willing to provide on-site job-specific training during the full orientation period as needed.
• Exhibits professionalism and common courtesy.

Qualifications and Skills Required

• Minimum 3 years in US medical billing; oncology, infusion, or surgical billing preferred.
• Strong understanding of CPT/HCPCS, ICD-10, modifiers, and payer billing rules.
• Experience with billing platforms (e.g., Epic, NextGen, eClinicalWorks, Athena).
• Familiarity with EOB/ERA interpretation, claim lifecycle, and denial codes.
• Ability to monitor performance and recommend workflow improvements.
• Proficient in Microsoft Office Suite, especially Excel for reconciliation and reporting.
• Certification in Medical Billing or RCM (AAPC, AHIMA) is a plus.
• Excellent customer service skills.
• Effective interpersonal and communication skills.
• Demonstrates a positive and professional behavior in the workplace.
• Ability to monitor/access performance of self, other individuals, or organization to recommend improvement regarding workflow, processes, and procedures.
• Ability to build and maintain trusting relationships.
• Ability to modify strategies for different types of learning styles and offer alternative approaches in the education process.
• Adapts to new and/or changing environments, supports innovation and change.
• Minimum of 6 months experience in current Patient Accounting role.