Job
Description
Location: Hyderabad, India Department: RCM Operations Work Type: Full Time - Work From Office Work Timing: U.S Shift ( EST/ CST / PST) Reports to: Senior Director RCM Operations Position Overview: The Purpose of the Position is to Provide operational guidance, value creation and help deliver customer expectations as defined as per SLA, identify areas for improvement and develop strategies to achieve the contractual metrics and relevant Operational standard for Provider / RCM Operations [ ex. HFMA standards]. The Revenue Cycle Management Operations role involves overseeing the entire revenue cycle process, from patient registration and billing to claims processing and collections, with the goal of maximizing revenue and ensuring financial stability. The aim of this position is to generate and maximize revenue opportunity for the programs assigned, meet the business transformational goals, improve efficiency and utilization of resources deployed and achieve excellent customer and employee satisfaction scores. This position needs Analyzing and interpreting of data while repositioning Benefit, Costs, and other key performance indicators to help identify areas for improvement and develop strategies to optimize delivery and help design a operational transformational matrix. Key Position Responsibilities: A. Leadership, Awareness: 1. Exceptional in RCM domain and understands the delivery and solutions landscape in RCM domain. 2. A self-motivating leader who can ideate, implement, help develop and execute innovative strategies for healthcare, RCM operations to achieve business objectives and improve overall efficiency and effectiveness. 3. The Revenue Cycle Management Operations role involves overseeing the entire revenue cycle process, from patient registration and billing to claims processing and collections, with the goal of maximizing revenue and ensuring financial stability. 4. Continuously seek opportunities for process improvement and implement changes accordingly. B. Provider / RCM Operations: 1. Manage projects related to Provider Operations/ RCM, including system enhancements, process improvements, and data migration initiatives. 2. Claims Management: Oversee claims submission, tracking, and follow-up processes to minimize claim denials and delays. 3. Manage multiple site based operations for different clients 4. Deep understanding & decision making ability to reduce denial rates & improve insurance collection 5. Project Management skills to reduce AR aging and timely follow ups for cash increase 6. End to End understanding of healthcare RCM KPI’s and how to drive them real time 7. Detailed understanding of Headcount Management and reconciliation for optimum utilization of resources 8. End to end understanding of Transaction & FTE billing techniques & hence implement structured processes to generate business outcomes C. Data Governance: 1. Develop and implement data governance strategies and policies to ensure consistent and standardized management of provider data across the organization. Establish data quality metrics and monitor data accuracy and completeness. D. Stakeholder Management: 1. Collaborate with internal stakeholders, including contracting, network management, claims, and other departments, to ensure accurate provider data for operational and reporting needs. Address and resolve provider data-related issues and inquiries. 2. Proficient in collaborating and working through multiple internal functions (Technology, CRM, Operations and Sales). Take responsibility for driving transformational projects and for cross-selling new services to clients. E. Compliance and Regulatory Adherence: 1. Ensure compliance with federal, state, and local regulations related to healthcare RCM, including but not limited to HIPAA, HITECH Act, NSA, and ACA. 2. Develop and maintain policies and procedures that promote adherence to regulatory requirements, conducting regular audits and assessments to identify and address compliance gaps. 3. Keep up to date with changes in healthcare regulations and RCM policies, providing guidance and training to staff members to ensure awareness and compliance. F. Performance Reporting & Continuous Improvements: 1. Develop and maintain performance metrics and key performance indicators (KPIs) for Provider Operations/ RCM operations. Prepare and present regular reports on data accuracy, timeliness, and process efficiency to management. 2. Stay informed about industry trends, advancements in Provider Operations/ RCM technologies, and best practices. Continuously seek opportunities for process improvement and implement changes accordingly. Qualifications and Requirements: 1. Bachelor's degree in healthcare administration, business administration, or a related field. A master's degree is preferred. 2. An overall U.S healthcare experience between 10-14 years with extensive operational experience (typically 5-8 years in RCM) Provider Operations/ RCM or a related field. 3. Excellent collaboration and influencing skills and ability to work in a metricized organization. 4. Strong leadership and managerial skills with a proven track record of successfully leading and developing high-performing teams. 5. 3 years’+ experience on Service Delivery Transformation (RPA/ Robotics) areas in RCM BPM Services. in addition to being well versed in the current Provider Solutions healthcare literature. 6. Excellent analytical, problem-solving, and decision-making abilities. 7. Exceptional communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders. 8. Strong understanding of compliance requirements and experience in ensuring adherence to regulations. 9. Proficiency in using RCM software, data analysis tools, and Microsoft Office Suite. Domain Skills: In-depth knowledge and exposure in managing in revenue cycle management, including leadership roles into Operations. Education & Certifications: Preferably Graduate / MBA from reputed universities. Preferably Six Sigma / Lean Sigma – Green Belt/ Black Belt certified. Relevant industry certifications (e.g., Certified Professional in Healthcare Management, Certified Revenue Cycle Specialist) are highly beneficial. Awareness of U.S Healthcare Governance, Compliance and Audit guidelines. Show more Show less
