1277 Hipaa Jobs - Page 16

RCM AR Analyst at Modernizing Medicine, Inc. Hyderabad, India We are united in our mission to make a positive impact on healthcare. Join Us! South Florida Business Journal, Best Places to Work 2024 Inc. 5000 Fastest-Growing Private Companies in America 2024 2024 Black Book Awards, ranked #1 EHR in 11 Specialties 2024 Spring Digital Health Awards, Web-based Digital Health category for EMA Health Records (Gold) 2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara) Who we are: We Are Modernizing Medicine ( WAMM )! We re a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling , we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMeds global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany. The Accounts Receivable Analyst is a key position within the ModMed India Operations. Analysts will be assigned to a group of practices under one or multiple specialties and are responsible for taking the appropriate actions to resolve claims with insurance balances that have no response or are being denied. Analysts will report to the RCM AR Lead. Your Role: Responsible for working assigned claims and running reports to identify claims that require a follow-up and resolve the denial by taking appropriate action as per Modmed guidelines. Ensuring timely follow up to save claims from getting written off due to untimely following up. Work on Contractual adjustments and write-off projects. Analyze previous notes and actions taken on claims; take the correct action on claims not handled correctly previously and bring that to the knowledge of the Quality Team. Identify opportunities to improve follow up process and recommend changes to be added/removed in the Practice Instructions or SOPs with any recent changes at the Payer end. Attend trainings to learn new updates, technologies, and techniques; enhancing knowledge of various scenarios and keeping abreast with the new updates is an important requirement for this role. Continuously self-audit to ensure quality standards are met. Review claim thoroughly and explore all possibilities to get claim resolved prior to assigning claims to any other Modmed or client buckets. Perform additional tasks or project work as assigned. Skills & Requirements: 2+ years of experience as AR Follow-ups (Voice) in Physician RCM is a must Sound knowledge of working on Billing scrubbers and CH/Payer Rejections Understanding of other related functions in the RCM is required Proven experience of good Cash collected/Resolution rate Strong knowledge of Commercial & Federal payers, basic Coding concepts & CARC codes Knowledge of working and resolving Auto, WC , IPAs etc. is required Expert in listening and resolving problems Ability to interact positively with team members, peer groups, and seniors Being proficient in delivering a high-quality outcome is a must Capable of grasping new concepts quickly; Able to comprehend various training aids and process documentation Excellent written and verbal communication skills Strong knowledge of HIPAA guidelines Abide by the organizations information security policy and protect the confidentiality, integrity, and availability of all information assets Willing to work from the office in India night shift (5:30PM to 2:30AM). Work from office ModMed Benefits Highlight: At ModMed, we believe it s important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits: India Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk, Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees, Allowances: Annual wellness allowance to support your well-being and productivity, Earned, casual, and sick leaves to maintain a healthy work-life balance, Bereavement leave for difficult times and extended medical leave options, Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave, Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind. United States Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution, 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep. Generous Paid Time Off and Paid Parental Leave programs, Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs, Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed, Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning , Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles, Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters. PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. . Please check senders email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website .

The purpose of this role is to create solution architectures for systems and platforms ensuring all relevant options are explored for time, cost and compliance to the company s standards, policies and practices while meeting the business requirements. The role will oversee the delivery of the solution for clients both internal and external, shepherding it through the relevant governance. Job Description: About the Role: We are seeking a highly skilled and visionary Solution Architect to join our organization and serve as the critical bridge between our engineering teams and business leadership. This individual will be responsible for translating complex business requirements into scalable, secure, and high-performance technical solutions across mobile applications, cloud-native platforms (AWS, Azure, GCP), and modern data pipelines (ETL, migration). The ideal candidate brings a balanced blend of technical expertise, strategic thinking, and excellent communication skills. They will guide development teams in best practices, drive architectural excellence, and ensure smooth, efficient delivery of enterprise-grade solutions. Key Responsibilities: Solution Design & Architecture Collaborate with clients and internal stakeholders to gather and understand business and technical requirements. Design robust, scalable, and maintainable architectures for: Mobile and web applications - Native and Cross Platform Cloud-native applications on AWS, Azure, or GCP Data processing pipelines, ETL workflows, and legacy-to-cloud data migrations Select appropriate technologies, tools, and platforms aligned with business goals. Define integration strategies, APIs, microservices, and event-driven systems. Data Strategy & Innovation Develop and evangelize data strategy including data governance, quality, lineage, and access patterns. Guide the design and implementation of ETL/ELT workflows, data lakes, data mesh, and data warehouse solutions (e.g., Databricks, Snowflake, Redshift, BigQuery). Ensure alignment with regulatory standards (GDPR, HIPAA, etc.). Explore and incorporate AI/ML and Generative AI capabilities into business solutions, including model integration, AI service orchestration, and responsible AI practices. Technical Leadership & Governance Champion software engineering best practices including CI/CD, DevOps, IaC (e.g., Terraform, CloudFormation). Conduct architectural reviews, code audits, and provide technical mentorship to developers. Establish development benchmarks, coding standards, and deployment guidelines. Stakeholder Communication Act as a liaison between technical teams and business leaders, translating technical concepts into business value. Present architecture proposals and trade-offs to executives and clients. Document solutions clearly for technical and non-technical stakeholders. Team Enablement & Mentorship Mentor and support engineering teams to ensure alignment with architectural vision and standards. Foster a culture of continuous improvement and innovation. Conduct technical reviews, audits, and retrospectives. Qualifications: Education: Bachelors or Masters degree in Computer Science, Engineering, or a related field. Experience: 10+ years in software development, with at least 4+ years in a solution or enterprise architecture role. Proven experience designing solutions across cloud platforms (AWS, Azure, GCP). Solid understanding of mobile application development and deployment (iOS/Android). Expertise in data integration, transformation (ETL), and migration projects. Experience with AI/ML or Generative AI implementation is a strong plus. Technical Skills: Proficient in modern data stack: tools like Airflow, dbt, Kafka, Spark, Fivetran, Snowflake, BigQuery. Knowledge of MLOps frameworks, LLM integrations, and vector databases (e.g., Pinecone, FAISS, Weaviate). Strong understanding of RESTful APIs, GraphQL, containers (Docker, Kubernetes), and serverless architectures. Strong knowledge of microservices, APIs, containers (Docker, Kubernetes), and serverless architectures. Hands-on experience with DevOps tools and cloud-native development patterns. Familiarity with databases (SQL, NoSQL) and data warehousing concepts. Soft Skills: Excellent interpersonal and communication skills, with the ability to present to technical and non-technical audiences. Strategic thinker with a pragmatic approach to solving complex problems. Strong organizational and project management skills. Nice to Have: Certification in cloud architecture (e.g., AWS Certified Solutions Architect, Azure Solutions Architect Expert, GCP Professional Cloud Architect). Familiarity with Agile/Scrum methodologies. Experience in regulated industries (e.g., finance, healthcare). Location: Pune Brand: Merkle Time Type: Full time Contract Type: Permanent

Responsibilities Partner with a qualified global team of cyber security risk management professionals to protect company assets and support security risk initiatives. Work cooperatively with the Risk and other leads to validate appropriateness of procedures and controls (to ensure compliance with regulatory, contractual, and legal requirements). Work collaboratively with Internal Audit, Legal, and business units to track risk reduction over time. Develop and maintain expertise in regulatory trends, client contractual trends, and risk management strategies. Provide monthly, quarterly, bi-annual, and annual metrics to track, validate, and provide continuous improvement to the compliance and risk management programs. Support the development of and enhance a governance framework aligned with ISO27001 to ensure compliance with stated metrics and documented controls. Maintain a risk register aligned with Omnicom s Risk Management Framework as it pertains to regulatory and compliance risks. Measure compliance with policy and standards as part of assessing the overall security risk posture of the enterprise and develop remediation plans as needed. Qualifications Bachelors degree required, preferably in computer science, information systems, engineering, business administration, or related field 5 years of experience required. In-depth understanding of common regulatory frameworks (SOX, HIPAA, PCI, GDPR) Practical knowledge of risk assessment and management approaches and delivery Knowledge of common information security management frameworks, such as ISO/IEC 27001, ITIL, COBIT and NIST Past Media and Entertainment industry experience Skills/Abilities Excellent written and verbal communication skills, interpersonal and collaborative skills, and the ability to communicate security and risk-related concepts to technical and nontechnical audiences. Excellent problem solving and analytical skills, individual must be a team player, strategic and analytical thinker, able to think big picture , as well as focus on trends and data coupled with industry themes, and able to multi-task on projects. Ability to build-out risk & compliance strategy aligned with business objectives that will continually improve and enhance cybersecurity within the organization. Demonstrate the ability to manage multiple projects under strict timelines, as well as the ability to work well in a demanding, dynamic environment and meet overall objectives. Possess a strong technology background with the ability to challenge or validate technology decisions from a position of knowledge and experience. Possess the ability to rapidly assimilate business strategies, coupled with the insight to seize high impact opportunities by applying creative problem-solving solutions. Track record of managing across multiple global locations, with a solid understanding of the challenges and benefits

ResMed has always applied the best of technology to improve peoples lives. Now our SaaS technology is fueling a new era in the healthcare industry, with dynamic systems that change the way people receive care in settings outside of the hospital-and tools that work every day to help people stay well, longer. We have one of the largest actionable datasets in the industry, creating a complete view of people as they move between care settings. This is how we empower providers-with vital insight to deliver the care people need, right when they need it. Revenue Cycle Representative We are a dynamic Revenue Cycle Management (RCM) and software company committed to delivering exceptional billing services and innovative solutions to our clients. We are seeking a high-caliber individual who is passionate about healthcare billing and eager to grow within a fast-paced, collaborative environment. Position Summary The Revenue Cycle Representative is responsible for providing accurate and timely billing services to both software and non-software clients. This role plays a key part in maintaining client satisfaction and ensuring the financial health of our customers through effective claims management and reimbursement follow-up. Key Responsibilities Submit claims promptly to Medicare, Medicaid, and private payers. Verify that claims are processed correctly and accepted by payers. Process adjustments and re-file claims as necessary. Collaborate with team members to manage accounts receivable (AR) for clients. Investigate and resolve reimbursement issues and perform claim follow-up. Meet or exceed established productivity benchmarks. Build and maintain strong client relationships, assisting with billing inquiries and claim resolutions. Address and resolve client concerns in a timely and professional manner. Escalate unresolved issues to appropriate departments or management. Maintain up-to-date knowledge of Medicare rules, regulations, and billing codes. Ensure compliance with HIPAA and confidentiality standards. Perform other duties as assigned. Qualifications Minimum of 1-4 years of progressive experience in Home Health and/or Hospice billing . Prior experience with Medicare billing rules and codes (preferred) . High school diploma or equivalent required; college degree preferred. Proficient in basic bookkeeping and statistical compilation. Strong organizational and multitasking skills. Excellent written and verbal communication abilities. Comfortable using computers, office equipment, and learning new systems. Professional, courteous, and adaptable demeanor. Ability to work independently and collaboratively in a dynamic environment. Willingness to engage with cross-functional teams to support client needs. Why Join Us? Opportunity to grow with a forward-thinking RCM and software company. Supportive team culture with a focus on continuous improvement. Competitive compensation and benefits package. Flexible work environment and career development opportunities. We commit to respond to every applicant.

ResMed has always applied the best of technology to improve peoples lives. Now our SaaS technology is fueling a new era in the healthcare industry, with dynamic systems that change the way people receive care in settings outside of the hospital-and tools that work every day to help people stay well, longer. We have one of the largest actionable datasets in the industry, creating a complete view of people as they move between care settings. This is how we empower providers-with vital insight to deliver the care people need, right when they need it. Revenue Cycle Representative - Auth & Eligibility We are a dynamic Revenue Cycle Management (RCM) and software company committed to delivering exceptional billing services and innovative solutions to our clients. We are seeking a high-caliber individual who is passionate about healthcare billing and eager to grow within a fast-paced, collaborative environment. Position Summary The Revenue Cycle Representative is responsible for providing accurate and timely billing services to both software and non-software clients. This role plays a key part in maintaining client satisfaction and ensuring the financial health of our customers through effective claims management and reimbursement follow-up. Responsibilities: Monitor and follow up on Eligibility & Authorization requirements for assigned agencies census. Submit claims timely to Medicare, Medicaid and Private Payers for software clients and non-software clients. Ensures that the claims processed correctly and were accepted by the payer. Process adjustments and re-file claims as needed. Member of a cohesive team that works to maintain the AR for HEALTHCAREfirst customers Troubleshoot reimbursement issues and claim follow-up Works at the established Productivity level Builds relationships with clients regarding their billing needs and assist with claim resolutions as needed. Addresses client concerns in a timely manner Escalates unresolved customer grievances to the proper department, or management for further assessment. Understanding of Medicare rules, regulations, billing codes Maintain confidentiality and knowledge of HIPAA regulations Performs other duties as assigned Qualifications: Minimum 1-3 years of progressive Home Health and/or Hospice billing experience preferred. Prior experience working with Medicare rules, regulations, billing codes (preferred) Education equivalent to a High school diploma, college degree preferred Ability to perform basic bookkeeping and compile statistics as needed Ability to work independently Must be organized and able to multitask Strong written and verbal communication skills Ability to type, operate computers and office equipment Aptitude for learning computer systems Ability to perform basic bookkeeping and compile statistics as needed Maintain a professional demeanor, courteous and flexible at all times Open to dynamic change and ability to thrive in such an environment Willingness and ability to work effectively with members of other departments We commit to respond to every applicant.

Primary Responsibilities: Lead a team of 75-90 certified coders. Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe, secure, and legal work environment; developing personal growth opportunities Performance Management Timeliness, Quality and Productivity metrics Planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards Maintains quality service by enforcing quality and customer service standards; analyzing and resolving quality and customer service problems; identifying trends; recommending system improvements Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Graduate in any discipline Experience in Performance Management, Project Management, Coaching, Supervision, Quality Management, Results Driven, Developing Budgets, Developing Standards, Foster Teamwork, Handles Pressure, Giving Feedback Proven ability to use Microsoft Office Products (Excel, PowerPoint etc) Proven ability to operate basic office equipment (copier and facsimile machine) Preferred Qualifications: Graduate of Life science Certified Professional Coder / Certified Coding Specialist with 2 years coding experience At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission. #NJP

Primary Responsibilities: Lead a team of 25 – 30 certified coders. Maintains staff by orienting and training employees; maintains a safe, secure, and legal work environment Performance Management – Timeliness, Quality and Productivity metrics Planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards Maintains quality service by enforcing quality and customer service standards; analyzing and resolving quality and customer service problems; identifying trends; recommending system improvements Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies Drive employee engagement and retention activities by sharing company’s vision and goals, empowering employees on tasks as per their skill set, providing regular feedback etc. Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Graduate in any discipline Certified coder from AAP/AHIMA 2+ years of experience as Team leader or Assistant Manager Experience in handling a team of minimum 15 Experience from medical coding background only Experience in performance management, coaching, supervision, quality management, results driven, foster teamwork, handles pressure, giving feedback Proven ability to use Microsoft Office Products (Excel, PowerPoint etc.) Proven ability to operate basic office equipment (copier and facsimile machine) At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone – of every race, gender, sexuality, age, location and income – deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission. #njp #SSCorp External Candidate Application Internal Employee Application

Position Summary As a staff engineer you will be part of development team and apply your expert technical knowledge, broad knowledge of software engineering best practices, problem solving, critical thinking and creativity to build and maintain software products that achieve technical, business and customer experience goals and inspire other engineers to do the same. You will be responsible towards working with different stakeholders to accomplish business and software engineering goals.Key duties & responsibilitiesEstimates and develops scalable solutions using .Net technologies in a highly collaborative agile environment with strong experience in C#, ASP.net Core, Web API.Maintain relevant documentation around the solutions. Conducts Code Reviews and ensures SOLID principles and standard design patterns are applied to system architectures and implementations.Evaluates, understands and recommends new technology, languages or development practices that have benefits for implementing.Collaborate with the Agile practitioners to help avoid distractions for the team, so that the team is focused on delivering their sprint commitments.Drive adoption of modern engineering practices such as Continuous Integration, Continuous Deployment, Code Reviews, TDD, Functional\Non-Functional testing, Test Automation, Performance Engineering etc. to deliver high-quality, high-value softwareFoster a culture and mindset of continuous learning to develop agility using the three pillars transparency, inspection and adaptation across levels and geographies.Mentors other members of the development team.Leads sessions with scrum team members to structure solution source code and designs implementation approaches optimizing for code that follows engineering best practices, and maximizes maintainability, testability and performance.Relevant exposure to agile ways of working preferably Scrum and KanbanSkills and KnowledgeB.E/B. Tech/MCA or equivalent professional degree5-8 years of experience designing and developing n-tier Web applications using .Net Framework, .Net Core, ASP.Net, WCF and C#, MVC 4/5 Web Development, RESTful API Services, Web API and JSONWell versed with C#, modern UI technologies and database\ORM technologies.Must have solid understanding of modern architectural and design patterns.Comprehensive knowledge of automation testing and modern testing practices e.g., TDD, BDD etc.Strong exposure in one or more Implementation of CI & CD using Jenkins, Dockers containerization.Strong exposure to Agile software development methodologies and enabling tools such as Jira, ConfluenceExcellent communicator with demonstrable ability of influencing decisionsKnowledge of healthcare revenue cycle management, HL7, EMR systems, HIPAA, FHIR would be preferred.Good to have knowledge on Azure Cloud.Good working understanding of application architecture concepts like microservices, Domain-Driven Design, broker pattern/message bus, event-driven, CQRS, ports & adapters/hexagonal/onion, SOA would be preferredKey competency profileSpot new opportunities by anticipating change and planning accordingly.Find ways to better serve customers and patients.Be accountable for customer service of highest quality.Create connections across teams by valuing differences and including others.Own your development by implementing and sharing your learnings.Motivate each other to perform at our highest level.Help people improve by learning from successes and failures.Work the right way by acting with integrity and living our values every day.Succeed by proactively identifying problems and solutions for yourself and others. r1rcm.com Facebook

Position Summary You will manage and oversee the development & deployment of high-quality software products. You will ensure that the development teams adopt and follow modern engineering practices to deliver a high-quality, high-value product. You will be responsible towards working with different stakeholders to accomplish business and software engineering goals. You will improve the teams capabilities, improve engagement, and minimize business risks. Key duties & responsibilities Develop high performing teams that are equipped with right capabilities in terms of skills, tools, technology, and resources to continuously deliver high-quality and high-value software. Collaborate with the -Agile practitioners to help avoid distractions for the team, so that the team is focused on delivering their sprint commitments. Drive adoption of modern engineering practices such as Continuous Integration, Continuous Deployment, Code Reviews, TDD, Functional\Non-Functional testing, Test Automation, Performance Engineering etc. to deliver high-quality, high-value software for 2-3 scrum teams Craft individual development plans for team members and provide growth opportunities Mentor, coach and challenge the team members to continuously raise performance standards. Align the teams with organizations vision, mission and strategic priorities and act as a key communication channel between team and senior leadership. Assess and provide team members timely feedback and conduct 360 feedback for self and teams assessment. Foster a culture and mindset of continuous learning improvement to develop agility using the three pillars transparency, inspection and adaptation across levels and geographies. Qualification B.E/B. Tech/MCA or equivalent professional degree Experience 10+ years of experience in building web-based enterprise software using Microsoft .NET technology stack. Demonstrable experience of leading teams of highly skilled software engineers (15-25 team members) and working successfully across cultures. Must have solid understanding of modern architectural and design patterns. Comprehensive knowledge of automation testing and modern testing practices e.g. TDD, BDD etc. Well versed with C#, modern UI technologies and database\ORM technologies. Strong exposure to Agile software development methodologies and enabling tools such as Jira, Confluence Excellent communicator with ability demonstrable ability of influencing decisions Knowledge of healthcare revenue cycle management, HL7, EMR systems, HIPAA, FHIR would be preferred. Key competency profile Spot new opportunities by anticipating change and planning accordingly Find ways to better serve customers and patients. Be accountable for customer service of highest quality Create connections across teams by valuing differences and including others Own your development by implementing and sharing your learnings Motivate each other to perform at our highest level Help people improve by learning from successes and failures Work the right way by acting with integrity and living our values every day Succeed by proactively identifying problems and solutions for yourself and others. r1rcm.com Facebook

Who we are: R1 is a leading provider of technology-driven solutions that help hospitals and health systems to manage their financial systems and improve patients experience. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, Al, intelligent automation and workflow orchestration. R1 is a place where we think boldly to create opportunities for everyone to innovate and grow. A place where we partner with purpose through transparency and inclusion. We are a global community of engineers, front-line associates, healthcare operators, and RCM experts that work together to go beyond for all those we serve. Because we know that all this adds up to something more, a place where we're all together better. R1 India is proud to be recognized amongst Top 25 Best Companies to Work For 2024, by the Great Place to Work Institute. This is our second consecutive recognition on this prestigious Best Workplaces list, building on the Top 50 recognition we achieved in 2023. Our focus on employee wellbeing and inclusion and diversity is demonstrated through prestigious recognitions with R1 India being ranked amongst Best in Healthcare, amongst Top 50 Best Workplaces for Millennials, Top 50 for Women, Top 25 for Diversity and Inclusion and Top 10 for Health and Wellness. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare work better for all by enabling efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 17,000+ strong in India with presence in Delhi NCR, Hyderabad, Bangalore, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Designation Specialist Training (4I) Role Objective Key Performance Indicators (KPI) What are the measurable indicators for the role Measurable Deliverables Training Throughput - Weightage (30%) First Pass Attempt - Weightage (25%) Production & Quality - Weightage (10%) Accurate & Time Data/MIS Reporting (15%) Basic Hygiene (Schedule Adherence, Responsiveness, Self-Conduct) - Weightage (10%) Trainee feedback - Weightage (5%) Projects (content development, any cost/ time/ FTE saving projects) - Weightage (5%) TNI / BQM management Essential Duties and Responsibilities Role typeIndividual Contributor Conduct new hire, refresher training on aligned process, domain, and tools Conduct process knowledge tests, analyse results and publish findings Work closely with quality and business to identify performance gaps for new hire trainees, create and execute remediation plans to improve trainee performance Achieve set targets on various training effectiveness parameters (level I, level II) Be responsible for training batch management: o Adherence to learning plan o Maintain all batch data and reporting as per the pre-set process o Manage batch logistics training invites, ID Request & Management o Take care of people issues in the batch (performance, disciplinary, schedule adherence, EWS etc.) o On time referred to HR cases alignment (absconding, NCNS, training rejects) Be an active and effective contributor in assigned projects (e.g., new work transition, any process content creation and dissemination, etc.) Continue with hands-on work processing for aligned processes for minimum 12 hours a month Participate in client calls, understand process/tools changes or upgrades, prepare required documentation for roll-out to the aligned process teams Be accountable for self-development/learning, create & complete individual development plan for self, continuously stay invested to be a subject matter expert Stay compliant with the HIPAA and other company policies/compliance : Effective giving and taking feedback, coaching, and mentoring skills Strong interpersonal skills and ability to manage varied trainee personality types Excellent verbal and written communication skills (esp. email communication) Self-motivated and self-driven with a knack for continuously upskilling self Team-player Certification NA Skill Set Qualification and technical skills required to execute the role. Candidate should be graduated and 3 years of exp in AR follow up role Technical Skills : Experience in Revenue Cycle Management for U.S. Healthcare & Expertise in AR Follow up end to end processes Understanding of Online Payer Portals Hands on in MS Office likePowerPoint, Excel, and Word Ability to use virtual communication platforms effectively likeTeams, Zoom, WebEx Experience levels required to execute this role Minimum of 3 years experience in RCM of U.S. healthcare industry (frontend, middle, backend as per role alignment) Overall experience Maximum 5 years Behavioral skills / competencies required for this role. E.g. Attention to detail Functional & Behavioral Skills Strong facilitation & presentation skills for both in-person & virtual environments Understanding of basics of content creation Pre-requisite Should have overall 7+ years of experience in RCM Operations Should have analytical skills & exhibit clear thinking/reasoning Should be able to comprehend & well-articulated to present his/her thought process well Should have excellent feedback and coaching skills r1rcm.com Facebook

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. We are looking for an immediate joiner who should have relevant exposure to Investigations Process with evidence gathering through fact finding and analysis. Primary Responsibility: Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Any other undergraduates or Postgraduates can apply (Except Medical Science and Life Science graduates) Knowledge of (HIPAA) laws pertaining to confidentiality of protected health information Demonstrated ability to identify documentation and medical record form(s) and make independent decisions within the scope of one’s job responsibilities Demonstrated ability to work in a team environment and to collaborate with a variety of professionals Demonstrated ability to work occasional off-hours schedules as required Proven extremely well versed with MS Office tools (Excel, Word and PowerPoint) Proven good data analytical skills combined with excellent communication skills Proven detail oriented and ability to be self-motivated to complete duties in a timely manner Proven attention to detail with solid organizational skills Proven basic analytical skills Preferred Qualification: Experience in healthcare domain At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. #njp

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. We are looking for an immediate joiner who should have relevant exposure to Investigations Process with evidence gathering through fact finding and analysis. Primary Responsibilities: Manage administrative intake of members Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review Handle resolution/inquiries from members and/or providers Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours. Required Qualifications: Any other undergraduates or Postgraduates can apply (Except Medical Science and Life Science graduates) Knowledge of (HIPAA) laws pertaining to confidentiality of protected health information Demonstrated ability to identify documentation and medical record form(s) and make independent decisions within the scope of one’s job responsibilities Demonstrated ability to work in a team environment and to collaborate with a variety of professionals Demonstrated ability to work occasional off-hours schedules as required Proven extremely well versed with MS Office tools (Excel, Word and PowerPoint) Proven good data analytical skills combined with excellent communication skills Proven detail oriented and ability to be self-motivated to complete duties in a timely manner Proven attention to detail with solid organizational skills Proven basic analytical skills Preferred Qualification: Experience in healthcare domain At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. #njp

Associate Manager - Data Privacy : We are seeking a highly motivated and detail-oriented Associate Manager to join our DataPrivacy team. This role involves assisting in the development, implementation, and maintenanceof our data privacy program. As an Associate Manager - Data Privacy, you will help driveprivacy initiatives and ensure organizational compliance with applicable data protectionregulations, including Indias Digital Personal Data Protection Act (DPDPA). The ideal candidatewill have a strong understanding of data privacy laws, regulations and best practices, coupledwith excellent communication, critical thinking, and analytical skills. On a day-to-day basis, youwill be expected to leverage your expertise in privacy laws, concepts, and industry standards tounderstand and navigate complex environments and ensure robust privacy practices. LocationBangalore, HQ, full-time Reports toSenior Manager - Data Privacy FunctionData Privacy, Data Governance, and Data Ethics | Compliance Key Responsibilities: Assist in the development and implementation of privacy program components, includingdrafting and refining policies, procedures, and templates; assist in DPDPAimplementation efforts Collaborate with business and product teams to assess and understand theorganizations use of personal data; serve as the key privacy advisor and point ofcontact for internal stakeholders, guiding privacy-related decisions. Research and monitor evolving privacy laws, regulations, and industry practices / trends,and analyse their impact on our business. Conduct Data Protection Impact Assessments (DPIAs) and risk assessments toproactively address and mitigate privacy risks. Enhance the organizations existing consent management framework in alignment withlegal and regulatory requirements, ensuring seamless integration across functions. Review privacy clauses in vendor contracts and ensure compliance with data protectionrequirements; provide assistance on the third party risk management process to mitigateprivacy risks. Help investigate and manage privacy incidents, including support with reporting andresolution. Support in handling data principle requests and ensure timely responses; assist inaddressing queries related to data privacy rights and data protection practices. Assist with continuous monitoring and testing of existing privacy controls implementedacross businesses, identify gaps, and initiate corrective measures. Assist data discovery activities across the enterprise; ensure maintenance of personaldata inventory. Assist design and delivery of mandatory privacy training and role-specific awarenessprograms to increase privacy awareness. Qualifications and : Bachelors / Masters Degree in Computer Science, Law, Information Security, Privacy,or related fields 4-6 years of overall experience working in the Privacy domain In-depth knowledge of global privacy laws and frameworks, including GDPR, DPDPA,CCPA, Information Technology Act, and regulations from RBI, SEBI, IRDAI and otherregulators Strong documentation and communication skills and proficiency with frameworkdevelopment, assessments, and policy and procedure documentation; advancedworking knowledge of MS Office applications Team player; ability to interface and build relationships with stakeholders Strong bias for action with exceptional problem solving skills Good to have: Professional certifications such as DCPP, DCPLA, CIPP/E, CIPM, CIPT, or equivalentare desirable Experience working in the FinTech industry and understanding of various products andservices PhonePe Full Time Employee Benefits (Not applicable for Intern or Contract Roles) Insurance Benefits - Medical Insurance, Critical Illness Insurance, Accidental Insurance, Life Insurance Wellness Program - Employee Assistance Program, Onsite Medical Center, Emergency Support System Parental Support - Maternity Benefit, Paternity Benefit Program, Adoption Assistance Program, Day-care Support Program Mobility Benefits - Relocation benefits, Transfer Support Policy, Travel Policy Retirement Benefits - Employee PF Contribution, Flexible PF Contribution, Gratuity, NPS, Leave Encashment Other Benefits - Higher Education Assistance, Car Lease, Salary Advance Policy Working at PhonePe is a rewarding experience! Great people, a work environment that thrives on creativity, the opportunity to take on roles beyond a defined job description are just some of the reasons you should work with us. Read more about PhonePe on our blog. Life at PhonePe PhonePe in the news

Vista IT Solutions Pvt. Ltd. - Indore, Madhya Pradesh Exp : 4-6 Years/ Job Type : Full Time Vista IT Solutions is building a high-performance IT operations team to support our 24×7 Managed Services delivery. We are hiring an experienced Systems Administrator with proven skills in Office 365, Azure, network security, virtualization, disaster recovery, and endpoint protection . This role requires strong ownership, deep technical expertise, and the ability to contribute within a globally distributed support structure. You will collaborate closely with team members across geographies to ensure high-quality service delivery. Department: Managed IT Services & Security Operations Location: Global MSP Team (24×7 Support Environment) Requirements Key Responsibilities Administer and support Microsoft 365 tenant environments including Exchange Online, Teams, OneDrive, SharePoint, Intune, and compliance settings Manage Azure services including virtual networks, resource groups, Azure AD, backup vaults, and security baselines Maintain VMware-based virtualized infrastructure (HP/Dell servers) Configure and secure SonicWall firewalls and Cisco switches; manage VLANs, routing, access control, and VPNs Deploy and manage EDR/MDR using Malwarebytes or equivalent tools Execute and monitor backup and disaster recovery operations using Veeam and Wasabi Handle patching, firmware updates, and RMM tool management (Barracuda RMM currently used) Oversee 3CX VoIP systems and ensure QoS, failover, and provisioning Implement and maintain cybersecurity best practices (Zero Trust, MFA, security policy hardening, threat response) Participate in 24×7 shift coverage, escalations, and weekend/on-call rotations as part of a global MSP support model Document configurations, SOPs, diagrams, and client-specific runbooks Required Skills & Experience 4+ years as a Systems Administrator or similar hands-on infrastructure/security role Strong knowledge of Microsoft 365 & Azure (administration, security, and compliance settings) Experience with VMware (ESXi, vCenter) virtualization platforms Proficiency with SonicWall firewalls, Cisco switching, routing protocols, and VPNs Hands-on experience with Veeam backup and Wasabi cloud storage Familiarity with endpoint security tools and threat response procedures Strong documentation, communication, and task ownership capabilities Experience working in an MSP or multi-client IT service environment is preferred Preferred/Bonus Skills Azure certifications (AZ-104, SC-200) or M365 (MS-102) Cisco or SonicWall certifications (CCNA, SNSA) Experience evaluating and transitioning RMM tools Familiarity with compliance frameworks (HIPAA, SOC 2) Mentoring or onboarding experience for technical team members What We Offer A globally collaborative work environment and impactful client-facing projects Opportunity to work with enterprise-grade technologies and diverse client stacks Career growth and role evolution as we expand managed services and cybersecurity functions Flexibility in rotational shifts within a stable, process-oriented team This is position is for night shift and work from office.

Role : Data Modeler Lead Location : Remote Experience : 10years+ Healthcare experience is Mandatory Position Overview : We are seeking an experienced Data Modeler/Lead with deep expertise in health plan data models and enterprise data warehousing to drive our healthcare analytics and reporting initiatives. The candidate should have hands-on experience with modern data platforms and a strong understanding of healthcare industry data standards. Key Responsibilities : Data Architecture & Modeling : - Design and implement comprehensive data models for health plan operations, including member enrollment, claims processing, provider networks, and medical management - Develop logical and physical data models that support analytical and regulatory reporting requirements (HEDIS, Stars, MLR, risk adjustment) - Create and maintain data lineage documentation and data dictionaries for healthcare datasets - Establish data modeling standards and best practices across the organization Technical Leadership : - Lead data warehousing initiatives using modern platforms like Databricks or traditional ETL tools like Informatica - Architect scalable data solutions that handle large volumes of healthcare transactional data - Collaborate with data engineers to optimize data pipelines and ensure data quality Healthcare Domain Expertise : - Apply deep knowledge of health plan operations, medical coding (ICD-10, CPT, HCPCS), and healthcare data standards (HL7, FHIR, X12 EDI) - Design data models that support analytical, reporting and AI/ML needs - Ensure compliance with healthcare regulations including HIPAA/PHI, and state insurance regulations - Partner with business stakeholders to translate healthcare business requirements into technical data solutions Data Governance & Quality : - Implement data governance frameworks specific to healthcare data privacy and security requirements - Establish data quality monitoring and validation processes for critical health plan metrics - Lead eAorts to standardize healthcare data definitions across multiple systems and data sources Required Qualifications : Technical Skills : - 10+ years of experience in data modeling with at least 4 years focused on healthcare/health plan data - Expert-level proficiency in dimensional modeling, data vault methodology, or other enterprise data modeling approaches - Hands-on experience with Informatica PowerCenter/IICS or Databricks platform for large-scale data processing - Strong SQL skills and experience with Oracle Exadata and cloud data warehouses (Databricks) - Proficiency with data modeling tools (Hackolade, ERwin, or similar) Healthcare Industry Knowledge : - Deep understanding of health plan data structures including claims, eligibility, provider data, and pharmacy data - Experience with healthcare data standards and medical coding systems - Knowledge of regulatory reporting requirements (HEDIS, Medicare Stars, MLR reporting, risk adjustment) - Familiarity with healthcare interoperability standards (HL7 FHIR, X12 EDI) Leadership & Communication : - Proven track record of leading data modeling projects in complex healthcare environments - Strong analytical and problem-solving skills with ability to work with ambiguous requirements - Excellent communication skills with ability to explain technical concepts to business stakeholders - Experience mentoring team members and establishing technical standards Preferred Qualifications : - Experience with Medicare Advantage, Medicaid, or Commercial health plan operations - Cloud platform certifications (AWS, Azure, or GCP) - Experience with real-time data streaming and modern data lake architectures - Knowledge of machine learning applications in healthcare analytics - Previous experience in a lead or architect role within healthcare organization

Role : Data Modeler Lead Location : Remote Experience : 10years+ Healthcare experience is Mandatory Position Overview : We are seeking an experienced Data Modeler/Lead with deep expertise in health plan data models and enterprise data warehousing to drive our healthcare analytics and reporting initiatives. The candidate should have hands-on experience with modern data platforms and a strong understanding of healthcare industry data standards. Key Responsibilities : Data Architecture & Modeling : - Design and implement comprehensive data models for health plan operations, including member enrollment, claims processing, provider networks, and medical management - Develop logical and physical data models that support analytical and regulatory reporting requirements (HEDIS, Stars, MLR, risk adjustment) - Create and maintain data lineage documentation and data dictionaries for healthcare datasets - Establish data modeling standards and best practices across the organization Technical Leadership : - Lead data warehousing initiatives using modern platforms like Databricks or traditional ETL tools like Informatica - Architect scalable data solutions that handle large volumes of healthcare transactional data - Collaborate with data engineers to optimize data pipelines and ensure data quality Healthcare Domain Expertise : - Apply deep knowledge of health plan operations, medical coding (ICD-10, CPT, HCPCS), and healthcare data standards (HL7, FHIR, X12 EDI) - Design data models that support analytical, reporting and AI/ML needs - Ensure compliance with healthcare regulations including HIPAA/PHI, and state insurance regulations - Partner with business stakeholders to translate healthcare business requirements into technical data solutions Data Governance & Quality : - Implement data governance frameworks specific to healthcare data privacy and security requirements - Establish data quality monitoring and validation processes for critical health plan metrics - Lead eAorts to standardize healthcare data definitions across multiple systems and data sources Required Qualifications : Technical Skills : - 10+ years of experience in data modeling with at least 4 years focused on healthcare/health plan data - Expert-level proficiency in dimensional modeling, data vault methodology, or other enterprise data modeling approaches - Hands-on experience with Informatica PowerCenter/IICS or Databricks platform for large-scale data processing - Strong SQL skills and experience with Oracle Exadata and cloud data warehouses (Databricks) - Proficiency with data modeling tools (Hackolade, ERwin, or similar) Healthcare Industry Knowledge : - Deep understanding of health plan data structures including claims, eligibility, provider data, and pharmacy data - Experience with healthcare data standards and medical coding systems - Knowledge of regulatory reporting requirements (HEDIS, Medicare Stars, MLR reporting, risk adjustment) - Familiarity with healthcare interoperability standards (HL7 FHIR, X12 EDI) Leadership & Communication : - Proven track record of leading data modeling projects in complex healthcare environments - Strong analytical and problem-solving skills with ability to work with ambiguous requirements - Excellent communication skills with ability to explain technical concepts to business stakeholders - Experience mentoring team members and establishing technical standards Preferred Qualifications : - Experience with Medicare Advantage, Medicaid, or Commercial health plan operations - Cloud platform certifications (AWS, Azure, or GCP) - Experience with real-time data streaming and modern data lake architectures - Knowledge of machine learning applications in healthcare analytics - Previous experience in a lead or architect role within healthcare organization

Healthcare experience is Mandatory Position Overview : We are seeking an experienced Data Modeler/Lead with deep expertise in health plan data models and enterprise data warehousing to drive our healthcare analytics and reporting initiatives. The candidate should have hands-on experience with modern data platforms and a strong understanding of healthcare industry data standards. Key Responsibilities : Data Architecture & Modeling : - Design and implement comprehensive data models for health plan operations, including member enrollment, claims processing, provider networks, and medical management - Develop logical and physical data models that support analytical and regulatory reporting requirements (HEDIS, Stars, MLR, risk adjustment) - Create and maintain data lineage documentation and data dictionaries for healthcare datasets - Establish data modeling standards and best practices across the organization Technical Leadership : - Lead data warehousing initiatives using modern platforms like Databricks or traditional ETL tools like Informatica - Architect scalable data solutions that handle large volumes of healthcare transactional data - Collaborate with data engineers to optimize data pipelines and ensure data quality Healthcare Domain Expertise : - Apply deep knowledge of health plan operations, medical coding (ICD-10, CPT, HCPCS), and healthcare data standards (HL7, FHIR, X12 EDI) - Design data models that support analytical, reporting and AI/ML needs - Ensure compliance with healthcare regulations including HIPAA/PHI, and state insurance regulations - Partner with business stakeholders to translate healthcare business requirements into technical data solutions Data Governance & Quality : - Implement data governance frameworks specific to healthcare data privacy and security requirements - Establish data quality monitoring and validation processes for critical health plan metrics - Lead eAorts to standardize healthcare data definitions across multiple systems and data sources Required Qualifications : Technical Skills : - 10+ years of experience in data modeling with at least 4 years focused on healthcare/health plan data - Expert-level proficiency in dimensional modeling, data vault methodology, or other enterprise data modeling approaches - Hands-on experience with Informatica PowerCenter/IICS or Databricks platform for large-scale data processing - Strong SQL skills and experience with Oracle Exadata and cloud data warehouses (Databricks) - Proficiency with data modeling tools (Hackolade, ERwin, or similar) Healthcare Industry Knowledge : - Deep understanding of health plan data structures including claims, eligibility, provider data, and pharmacy data - Experience with healthcare data standards and medical coding systems - Knowledge of regulatory reporting requirements (HEDIS, Medicare Stars, MLR reporting, risk adjustment) - Familiarity with healthcare interoperability standards (HL7 FHIR, X12 EDI) Leadership & Communication : - Proven track record of leading data modeling projects in complex healthcare environments - Strong analytical and problem-solving skills with ability to work with ambiguous requirements - Excellent communication skills with ability to explain technical concepts to business stakeholders - Experience mentoring team members and establishing technical standards Preferred Qualifications : - Experience with Medicare Advantage, Medicaid, or Commercial health plan operations - Cloud platform certifications (AWS, Azure, or GCP) - Experience with real-time data streaming and modern data lake architectures - Knowledge of machine learning applications in healthcare analytics - Previous experience in a lead or architect role within healthcare organization

Job Roles & Responsibilities: At least 10 years of Healthcare RCM Experience. Demonstrated leadership capabilities, including ability to organize and manage human resources to attain goals. Willingness to work US shifts. Expertise with MS Office tools like PowerPoint, Excel, etc. Preferred Qualification Any Graduate or above. Desired Skills: Develop the Operations strategy for the organization, keeping in mind the business requirements. Execute these innovative strategies to improve and secure business delivery. Drive and lead all the RCM and collection operations functions effectively with process improvements of existing processes. Performing operational due diligence for new prospective clients ? Manage onshore centers for Patient collections and Insurance billing. Experience in project transition will be a value add. Strong understanding of revenue cycle management and KPIs standards set to optimize insurance collection. Strong understanding of all downstream revenue cycle offices and experience of handling entire functions of Healthcare RCM - Payment posting, AR Follow-up, Denial Management & Patient Billing (Voice & Non voice) Should have experience in expanding operations and work on prospect clients, RFPs, SOPs and DOUs etc. Ensure that the portfolio/s meets client and internal company performance benchmarks. Actively develop the management capabilities and business acumen of direct reportees, and drives the development of team members, ensuring full and well- rounded team competency. Knowledge of company policies and procedures to be able to provide the right answers to inquiries from all customers (both internal and external) Excellent analytical, verbal and written - communication and presentation skills. Proficient in Excel and PowerPoint to create/read/analyze weekly reports, dashboards for both internal management and clients. Strong interpersonal skills to be able to effectively relate with the public, patients, organizations and employees. Staff development including training, coaching and competency assessment.

Job Roles & Responsibilities: Develop and execute innovative strategies to improve and secure business delivery. Able to establish pilot A/R process and devise strategy to improve collections. Strong understanding of revenue cycle management and KPIs standards set to optimize insurance collection. Strong understanding of all downstream revenue cycle offices i.e. Payment Posting, AR Followup/Denial Management, & Patient Billing. Understands the eccentricities of various provider specialties. Ensure that the portfolio meets client and internal company performance benchmarks. Actively develop the management capabilities and business acumen of direct reporters, and drives the development of team members, ensuring full and well- rounded team competency. Ability to execute policies, processes and procedures of the organization. Demonstrate leadership skills with experience managing 5-10 Teams. Excellent verbal and written communication and presentation skills. Experience of performing annual performance review/appraisals Proficient in Excel and PowerPoint to create weekly reports, dashboards for both internal management and client. Strong people management skills with fair understanding of required techniques to create winwin situation. Strong focus on Customer Service. Strong Employee Retention capabilities. Candidate Requirements: Minimum 14+ years of experience into End to End RCM Process and in depth knowledge of metrics and calculations. Either presently working as Associate Director or minimum 2 years as Senior Manager. Handled a team of 150+. Demonstrated leadership capabilities, including ability to organize and manage human resources to attain goals. Willingness to work night shifts. Expertise with MS Office tools like PowerPoint, Excel, etc. Preferred Qualification Any Graduate.

Position Overview : We are seeking an experienced Data Modeler/Lead with deep expertise in health plan data models and enterprise data warehousing to drive our healthcare analytics and reporting initiatives. The candidate should have hands-on experience with modern data platforms and a strong understanding of healthcare industry data standards. Key Responsibilities : Data Architecture & Modeling : - Design and implement comprehensive data models for health plan operations, including member enrollment, claims processing, provider networks, and medical management - Develop logical and physical data models that support analytical and regulatory reporting requirements (HEDIS, Stars, MLR, risk adjustment) - Create and maintain data lineage documentation and data dictionaries for healthcare datasets - Establish data modeling standards and best practices across the organization Technical Leadership : - Lead data warehousing initiatives using modern platforms like Databricks or traditional ETL tools like Informatica - Architect scalable data solutions that handle large volumes of healthcare transactional data - Collaborate with data engineers to optimize data pipelines and ensure data quality Healthcare Domain Expertise : - Apply deep knowledge of health plan operations, medical coding (ICD-10, CPT, HCPCS), and healthcare data standards (HL7, FHIR, X12 EDI) - Design data models that support analytical, reporting and AI/ML needs - Ensure compliance with healthcare regulations including HIPAA/PHI, and state insurance regulations - Partner with business stakeholders to translate healthcare business requirements into technical data solutions Data Governance & Quality : - Implement data governance frameworks specific to healthcare data privacy and security requirements - Establish data quality monitoring and validation processes for critical health plan metrics - Lead eAorts to standardize healthcare data definitions across multiple systems and data sources Required Qualifications : Technical Skills : - 10+ years of experience in data modeling with at least 4 years focused on healthcare/health plan data - Expert-level proficiency in dimensional modeling, data vault methodology, or other enterprise data modeling approaches - Hands-on experience with Informatica PowerCenter/IICS or Databricks platform for large-scale data processing - Strong SQL skills and experience with Oracle Exadata and cloud data warehouses (Databricks) - Proficiency with data modeling tools (Hackolade, ERwin, or similar) Healthcare Industry Knowledge : - Deep understanding of health plan data structures including claims, eligibility, provider data, and pharmacy data - Experience with healthcare data standards and medical coding systems - Knowledge of regulatory reporting requirements (HEDIS, Medicare Stars, MLR reporting, risk adjustment) - Familiarity with healthcare interoperability standards (HL7 FHIR, X12 EDI) Leadership & Communication : - Proven track record of leading data modeling projects in complex healthcare environments - Strong analytical and problem-solving skills with ability to work with ambiguous requirements - Excellent communication skills with ability to explain technical concepts to business stakeholders - Experience mentoring team members and establishing technical standards Preferred Qualifications : - Experience with Medicare Advantage, Medicaid, or Commercial health plan operations - Cloud platform certifications (AWS, Azure, or GCP) - Experience with real-time data streaming and modern data lake architectures - Knowledge of machine learning applications in healthcare analytics - Previous experience in a lead or architect role within healthcare organization

The IBM Cloud Platform Compliance team is looking for a talented, innovative and enthusiastic software development manager that will support the team building automation to make our customers succeed. IBM Cloud Platform Compliance has a global cloud presence that continues to grow and expand its reach. Our automation engineering team is responsible for delivering compliance at scale for all IBM Cloud platform services. As a trusted platform, first-rate security, fail-safe reliability and exceptional quality is of the utmost importance.As an IBM Cloud Engineering Manager, you will specialize in ensuring the reliability, resiliency and security of our systems. Bringing a unique blend of knowledge and skills in both software and systems, you will play a key role in analyzing business needs, identifying and solving problems, guiding solutions, and developing a high-performing team of developers and Site Reliability Engineers. You will work in an agile, collaborative environment where we build, deploy, configure and maintain systems for IBM. Working closely with our worldwide teams, you will have a unique opportunity to gain first-hand knowledge of the latest technologies and be supported by a global team of IBMers to grow your own skills and develop your career. Key Responsibilities: Provide guidance, coaching, and support to team members to help them grow professionally and achieve their career goals Maintain a high-performance culture through timely goal setting, feedback and regular conversations with team members Drive a culture of continuous improvement within the development team, encouraging innovation, experimentation, and knowledge sharing Ensure that projects are completed on time, and meet quality standards, supporting the team by removing blockers to progress Monitor project progress, identify risks and issues, and take proactive measures to address them Act as a focal for senior management by providing regular updates on project status, milestones, and deliverables Help manage stakeholder relationships Promote Agile and Design Thinking processes to streamline development workflows and produce technical output that delights our customers Actively participate in organization initiatives and activities to support employee engagement Work in a global team collaborating with IBMers to share recommendations, solutions and ideas Required education Bachelor's Degree Preferred education Master's Degree Required technical and professional expertise 10+ years’ experience working in software development 4+ years’ experience leading a software development team ensuring that commitments are upheld, and stakeholders are well managed Sustained experience in coaching and mentoring technical employees Demonstrated ability to set expectations in others and balance priorities to achieve desired deliverables Passion towards driving and delivering automation solutions to large, complex problems Ability to think analytically and communicate rational plans to colleagues Proven ability to lead and drive collaboration across teams to achieve desired outcomes Excellent written and verbal communication skills Flexibility to work with team members in other time zones Preferred technical and professional experience Understanding of Agile and experience coaching teams adopting the methodology and values Held a prior management position with HR responsibilities for employees Understanding of Cloud/DevSecOps/SRE Experience in Design Thinking Familiarity with any major cloud provider Familiarity with Docker, Kubernetes/OpenShift Knowledge of IT compliance frameworks, e.g. SOC2, PCI, HIPAA

We are seeking a dedicated and detail-oriented Quality Assurance Analyst to support and enhance the performance of our call center operations within the US healthcare domain . The QA Analyst will monitor and evaluate calls and customer interactions to ensure high-quality service delivery, compliance with healthcare regulations (HIPAA), and alignment with organizational standards. The ideal candidate will have experience in US healthcare customer service, strong analytical skills, and a passion for improving the member and provider experience Monitor inbound and outbound calls, chat, and email interactions for accuracy, professionalism, and compliance with policies and procedures. Evaluate agent performance based on pre-defined quality standards including customer service, technical accuracy, and adherence to scripts and regulations. Provide actionable feedback and coaching recommendations to supervisors and trainers to improve agent performance. Collaborate with call center leadership to develop and refine QA scorecards and quality metrics. Ensure compliance with HIPAA, CMS guidelines, and other regulatory standards. Identify trends, recurring issues, and training opportunities based on quality evaluations and customer feedback. Assist in the development and implementation of call center best practices and continuous improvement initiatives. Maintain detailed QA records and reports; present findings to management in a clear and actionable format. Participate in calibration sessions to ensure consistency in QA scoring across evaluators. Support special audits, complaint investigations, and root cause analysis as needed Bachelor s degree or equivalent work experience in healthcare, business, or a related field. 2+ years of quality assurance or call monitoring experience in a US healthcare call center environment . Familiarity with healthcare terms, insurance processes, member eligibility, provider inquiries, and claims inquiries. Strong understanding of HIPAA compliance and healthcare privacy regulations. Experience with QA tools and call recording systems (e.g., NICE, Verint, Genesys, Five9, Calabrio). Excellent verbal and written communication skills. Detail-oriented with strong analytical and problem-solving skills. Ability to work independently and collaboratively in a fast-paced environment

Educational Bachelor of Engineering,BCA,BTech,MCA,MTech,MBA Service Line Application Development and Maintenance Responsibilities A day in the life of an Infoscion As part of the Infosys delivery team, your primary role would be to interface with the client for quality assurance, issue resolution and ensuring high customer satisfaction. You will understand requirements, create and review designs, validate the architecture and ensure high levels of service offerings to clients in the technology domain. You will participate in project estimation, provide inputs for solution delivery, conduct technical risk planning, perform code reviews and unit test plan reviews. You will lead and guide your teams towards developing optimized high quality code deliverables, continual knowledge management and adherence to the organizational guidelines and processes. You would be a key contributor to building efficient programs/ systems and if you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you!If you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you! Technical and Professional : EDI, Edifecs, X12, 837 Claims, 834 enrollment processing Preferred Skills: Technology-Healthcare-EDI

Educational Bachelor of Engineering,BCA,BTech,MBA,MTech,MCA Service Line Application Development and Maintenance Responsibilities A day in the life of an Infoscion As part of the Infosys delivery team, your primary role would be to interface with the client for quality assurance, issue resolution and ensuring high customer satisfaction. You will understand requirements, create and review designs, validate the architecture and ensure high levels of service offerings to clients in the technology domain. You will participate in project estimation, provide inputs for solution delivery, conduct technical risk planning, perform code reviews and unit test plan reviews. You will lead and guide your teams towards developing optimized high quality code deliverables, continual knowledge management and adherence to the organizational guidelines and processes. You would be a key contributor to building efficient programs/ systems and if you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you!If you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you! Technical and Professional : Domain experiencePayer core – claims/Membership/provider mgmt. Domain experienceProvider clinical/RCM, Pharmacy benefit management Healthcare Business Analysts - with Agile/Safe-Agile Business analysis experience Medicaid, Medicaid experienced Business Analysts FHIR, HL7 data analyst and interoperability consulting Healthcare digital transformation consultants with skills/experience of cloud data solutions design, Data analysis/analytics, RPA solution design KeywordsClaims, Provider, utilization management experience, Pricing,Agile, BA Preferred Skills: Domain-Healthcare-Healthcare - ALL Technology-Analytics - Functional-Business Analyst