Role & responsibilities - The AR Associate is responsible for the accounts receivables aspects of the client-focused revenue cycle operations and must display in-depth knowledge and execute all standards operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership. Responsibilities Review outstanding insurance balances to identify and resolve issues preventing finalization of claim payment, including coordinating with payers, patient and client when appropriate. Analyze the trend data, recommending solutions to improve first pass denial rates and reduce age of overall AR. Account Receivable specialist that understands the whole accounting /claim life cycle. In-depth working knowledge of the various applications associated with the workflows i.e., Microsoft Office and Google Tools and more. Ensure all workflow items are completed within the set TAT within quality expectations. Able to analyze denial EOBs and denials at a claim level in addition to finding trends impacting the AR. Perform other duties as assigned by the Lead. Escalate difficult collection situations to management in a timely manner. Post cash and write off the contractual adjustments accordingly while working on the accounts If Required. Meeting daily/weekly and monthly targets set for an individual. Candidate should have good knowledge of Medicare, Medicaid & commercial payers and their denial codes and must be aware of how what are the appropriate actions required. Strong knowledge of Language Skill as American English with neutral accent. Communicates effectively with all internal and external clients. Uses good judgement and critical thinking skills; ability to identify and resolve problems. Possess a strong work ethic and a high level of professionalism with a commitment to client/patient/organization satisfaction. Functional knowledge of HIPPA rules and regulations and experience related to privacy laws, access and release of information. Ability to interact positively with team members, peers and seniors.
Python Developer is responsible for building, debugging, and implementing application projects using the Python programming language and developing program specifications and coded modules according to specifications and client standards. Responsibilities Advanced Python Programming: Extensive experience in Python, with a deep understanding of Python principles, design patterns, and best practices. Proficiency in developing scalable and efficient Python code, with a focus on automation, data processing, and backend services. Demonstrated ability with automation libraries like PyAutoGUI for GUI automation tasks, enabling the automation of mouse and keyboard actions. Experience with Selenium for web automation: Capable of automating web browsers to mimic user actions, scrape web data, and test web applications. Python Frameworks and Libraries: Strong experience with popular Python frameworks and libraries relevant to data processing, web application development, and automation, such as Flask or Django for web development, Pandas and NumPy for data manipulation, and Celery for task scheduling. SQL Server Expertise : Advanced knowledge of SQL Server management and development. API Development and Integration: Experience in developing and consuming APIs. Understanding of API security best practices. Familiarity with integrating third-party services and APIs into the existing ecosystem. Version Control and CI/CD: Proficiency in using version control systems, such as Git. Experience with continuous integration and continuous deployment (CI/CD) pipelines Unit Testing and Debugging: Strong understanding of testing practices, including unit testing, integration testing. Experience with Python testing. Skilled in debugging and performance profiling. Containerization and Virtualization: Familiarity with containerization and orchestration tools, such as Docker and Kubernetes, to enhance application deployment and scalability. Requirements & Skills Analytical Thinking : Ability to analyze complex problems and break them down into manageable parts. Strong logical reasoning and troubleshooting skills. Communication: Excellent verbal and written communication skills. Ability to effectively articulate technical challenges and solutions to both technical and non-technical team members. Team Collaboration : Experience working in agile development environments. Ability to work collaboratively in cross-functional teams and with stakeholders from different backgrounds. Continuous Learning : A strong desire to learn new technologies and frameworks. Keeping up to date with industry trends and advancements in healthcare RCM, AI, and automation technologies. . Additional Preferred Skills: Industry-Specific Knowledge is a plus: Familiarity with healthcare industry standards and regulations, such as HIPAA, is highly advantageous. Understanding of healthcare revenue cycle management processes and challenges. Experience with healthcare data formats and standards (e.g., HL7, FHIR) is beneficial. Educational Qualifications: Bachelors degree in a related field., Relevant technical certifications are a plus
Java Backend Developer Healthcare Interoperability (Java/Spring Boot) will be responsible for developing components of a Healthcare Interface Engine. This includes working on EHR connectors, data transformations, and scalable APIs, while collaborating with the architect to deliver secure and high-performance workflows. Responsibilities Build EHR connectors for inbound/outbound data (Epic, Athena, Cerner, etc.). Implement HL7 v2, FHIR R4, and X12 EDI transaction flows. Design, build, and maintain REST APIs for interoperability services. Handle transformations between JSON, XML, HL7 v2, and EDI. Implement queuing, retries, and error handling logic. Collaborate with architect on scalable and secure workflows. Troubleshoot, debug, and resolve technical issues across the stack, ensuring optimal performance and reliability. Stay current with emerging technologies and advocate for continuous improvement within the team. Technical Skills Required Strong in Java / Spring Boot and Spring Integration RESTful API development & security (OAuth2, JWT) Data transformation libraries (Jackson, Smooks, HAPI FHIR) Parsing HL7 v2, Json, FHIR & X12 EDI (837, 835) Messaging systems (Kafka / RabbitMQ etc) SQL/NoSQL databases (Postgres, Redis etc)
Software Architect Healthcare Interoperability is responsible for leading the design and development of a next-generation healthcare interface engine. This role involves integrating with various EHR systems such as Epic, Cerner, Athena, and Meditech, managing diverse data formats including HL7 v2, FHIR R4, X12/EDI, JSON, and XML, while ensuring the platform is scalable, compliant, and observable. Responsibilities Design the architecture for a custom interface engine supporting HL7 v2, FHIR (R4), and X12 EDI etc transactions. Define routing, transformation, and queuing strategies for high-volume healthcare data exchange. Integration with EHRs (Epic, Athena, Cerner, Meditech) and clearinghouses. Establish error handling, retries, monitoring, and resilience patterns (Resilience4j, circuit breakers, observability). Mentor developers, review designs/code, and enforce best practices. Technical Skills Required Java / Spring Boot (microservices, APIs, event-driven patterns) Integration frameworks: Apache Camel or Spring Integration Data mapping: Smooks, HAPI FHIR Message formats: HL7 v2, FHIR (STU3/R4), X12 EDI (837, 835, 270/271), JSON, XML, CSV etc Architecture & Infrastructure Cloud-native design (Azure / AWS) Kafka / RabbitMQ for messaging Observability: Grafana / Prometheus / ELK Security: OAuth2, JWT, mutual TLS, encryption at rest/in-transit Domain Knowledge Healthcare RCM (pre-billing edits, eligibility, claims, remittance) EHR APIs ( Epic App Orchard, Athena One, Cerner Ignite etc) Experience 10+ years in software engineering with 3+ years in healthcare interoperability.
We are seeking a skilled Data Integration Specialist with expertise in Electronic Health Records (EHR) and strong proficiency in HL7 and FHIR standards. The ideal candidate will have a deep understanding of healthcare data integration processes and will be responsible for ensuring seamless data flow between healthcare systems, improving interoperability, and optimizing data exchange across various platforms. The role demands expertise in FHIR R4 and the ability to implement and manage EHR systems efficiently. Responsibilities Data Integration: Design, implement, and maintain data integration solutions to connect EHR systems with other healthcare platforms, ensuring the exchange of accurate and secure patient information. FHIR & HL7 Standards: Develop and configure FHIR (R4) interfaces and HL7-based systems for seamless integration across various healthcare systems and third-party applications. EHR Systems Expertise: Work with Electronic Health Records (EHR) systems to enhance functionality, improve interoperability, and streamline workflows. Troubleshooting & Support: Identify, troubleshoot, and resolve integration issues, ensuring minimal downtime and disruption in healthcare services. Compliance & Security: Ensure that all data integration processes comply with HIPAA and other relevant healthcare regulations and standards. Collaboration: Collaborate with cross-functional teams, including software developers, project managers, and healthcare professionals, to understand requirements and implement integration solutions. Documentation: Maintain detailed documentation of integration processes, data mappings, and system configurations for future reference and compliance audits. Training & Knowledge Sharing: Provide training to internal teams on integration processes and tools, ensuring proper usage and understanding of new systems. Requirements & skills Experience: Minimum 5 years of experience in healthcare data integration, with a focus on EHR systems, HL7, and FHIR. Certifications: HL7 Certification FHIR R4 Certification Technical Skills: Hands-on experience with HL7 messaging protocols, FHIR standards, and EHR platforms. Proficiency in FHIR R4 and its applications in healthcare integration. Strong knowledge of data integration tools and platforms (e.g., Mirth Connect, Informatica, MuleSoft). Familiarity with RESTful APIs and web services. Education: Bachelors degree in computer science, Health Informatics, Information Technology, or related field . Communication Skills: Strong written and verbal communication skills, with the ability to work collaboratively in a cross-functional team Additional Preferred Skills: Experience with FHIR RESTful APIs and HL7 v2.x/v3 messaging standards. Background in healthcare data standards (CDA, CCD, CCDS). Understanding of interoperability frameworks and patient data exchange protocols. Prior experience working with cloud-based healthcare solutions (AWS, Azure, etc.). Familiarity with SQL and databases related to healthcare systems.
Maintain and monitor revenue cycle metrics for assigned client and provide strategies for dynamic improvement Provide and analyses data and undertake measures to improve efficiencies. Prepare operational reports and analysis reflecting progress, adverse trends and appropriate recommendations. Identify training gaps in the team and train them as appropriate/required on revenue cycle activities and practices. Ability to communicate, have excellent interpersonal, listening skills and organizational skills Well informed about current Revenue cycle concepts and best practices. Provide leadership and focus to the project teams. Responsible for the productivity, quality and overall performance of the projects. Preparing project reviews, transition & migration plans, and project feasibility reports. Managing SLA's and ensuring smooth service delivery. Managing Service Level Quality (Six Sigma Approach) & Lead Time Management. Lead teams to efficiently deliver client expectations. Guide team to reduce AR ageing and optimize collections. Manage day-to-day activities with the team, but not limited to. Monitoring and managing workflow or daily targets to assure timely delivery of agreed SLAs. Tracking and maintaining metrics for a variety of data including collections report, Operations report, etc. Develop processes to improve productivity and quality of the team. Participate in the new pilots projects & work towards proper transition of knowledge to team. Strong knowledge of Language Skill as American English with neutral accent. Communicates effectively with all internal and external clients along with proficiency in presentation. Uses good judgement and critical thinking skills; ability to identify and resolve problems. Possess a strong work ethic and a high level of professionalism with a commitment to client/patient/organization satisfaction. Preferred candidate profile Minimum 12 years of experience in the US Healthcare industry Minimum 1 year of managerial experience Work from Office Mohali Strong expertise in Revenue Cycle Management (RCM)
Role & responsibilities The Quality Manager is responsible for overseeing the implementation of processes, establishing robust governance, and delivering performance reporting to segment and sub-segment heads for Quality, Cost, and Product Delivery metrics. They are also responsible for understanding customer requirements, defining quality standards, and developing effective quality control processes. Provide strategic leadership to quality function with a responsibility to enhance the customer experience through Quality of deliverables. Promote and supervise facilitation and management of projects following AGILE methodology that tailor the project process to ensure compliance. Drive Quality Assurance and process compliance initiatives for projects within the segment. Promote and manage an effective Project Quality Status Reporting to Delivery Department in terms of Quality, Cost and Delivery parameters. Driving code quality, product quality, product security related initiatives Leads an assigned quality team. Prioritizes and assigns tasks to team members and checks progress of agreed transactions and workflows. Ensures real-time quality reporting for ad-hoc analysis, instant decision making, preventive action and continuous improvement. Contributes to budget planning processes. Ensures qualification and competences of the assigned team. Acts as an escalation point of contact for quality issues. Analyze quality data to identify trends and make data-driven recommendations. Develop and maintain relationships with internal and external Stakeholders vendors to support training and quality initiatives. Ensure that all training and quality initiatives align with the organization's overall strategy and goals. Developing quality control processes. Minimum Requirements Reporting to upper management on quality standard issues. Excellent attention to detail. Excellent verbal and written communication. Good interpersonal skills. Experience in implementation of Organization level improvement initiatives. High level of client management experience and Influencing skills Ability to define strategy for the teams to achieve business excellence. Strong presentation skills and ability to interact with various levels of management. Excellent interpersonal skills and ability to work independently on problems. Strong written and verbal communication
Responsibilities Design the architecture for a custom interface engine supporting HL7 v2, FHIR (R4), and X12 EDI etc transactions. Define routing, transformation, and queuing strategies for high-volume healthcare data exchange. Integration with EHRs (Epic, Athena, Cerner, Meditech) and clearinghouses. Establish error handling, retries, monitoring, and resilience patterns (Resilience4j, circuit breakers, observability). Mentor developers, review designs/code, and enforce best practices. Technical Skills Required Java / Spring Boot (microservices, APIs, event-driven patterns) Integration frameworks: Apache Camel or Spring Integration Data mapping: Smooks, HAPI FHIR Message formats: HL7 v2, FHIR (STU3/R4), X12 EDI (837, 835, 270/271), JSON, XML, CSV etc Architecture & Infrastructure: Cloud-native design (Azure / AWS) Kafka / RabbitMQ for messaging Observability: Grafana / Prometheus / ELK Security: OAuth2, JWT, mutual TLS, encryption at rest/in-transit Domain Knowledge: Healthcare RCM (pre-billing edits, eligibility, claims, remittance) EHR APIs ( Epic App Orchard, Athena One, Cerner Ignite etc) Experience 10+ years in software engineering with 3+ years in healthcare interoperability.
Education & Credentials: Bachelors degree in Nursing (BSN) or Bachelors in Physiotherapy or related field, Health Information Management, or related field (required) CDI Certification: CCDS (Certified Clinical Documentation Specialist) or CDIP (AHIMA) Clinical background (RN, MD, or HIM professional) with at least 37 years of CDI experience Experience: Proven experience in Clinical Documentation Integrity programs within acute care hospitals or physician practices Deep understanding of MS-DRG and APR-DRG assignment logic and the impact of documentation on reimbursement and quality metrics Experience in query creation, CC/MCC identification, severity of illness (SOI) and risk of mortality (ROM) scoring Exposure to case mix index (CMI) analysis and denial prevention related to documentation Familiarity with ICD-10-CM/PCS, CPT, and HCPCS coding guidelines Prior experience collaborating with product teams or developing logic/rules for CDI or RCM systems is a plus Key Responsibilities 1. CDI Logic Development: Define and document CDI logic rules and triggers based on national CDI guidelines and payer documentation requirements Develop condition-specific CDI rulesets (e.g., sepsis, respiratory failure, encephalopathy, malnutrition) Maintain mapping between diagnoses, clinical indicators, and supporting lab/imaging evidence Build logic libraries for query opportunities, denial risk flags, and missing documentation alerts 2. Standards and Compliance: Ensure all CDI logic aligns with AHIMA & ACDIS standards, CMS Official Coding Guidelines, and OIG compliance Monitor updates from CMS and other regulatory bodies and update CDI rules accordingly 3. Collaboration & Testing: Collaborate with product and data teams to translate CDI rules into machine-readable logic Participate in UAT (User Acceptance Testing) to validate CDI outputs and ensure logic accuracy Partner with SMEs in coding, quality, and utilization review to refine the CDI algorithms 4. Knowledge Management: Create and maintain a CDI knowledge base of condition-specific documentation guidance Train internal stakeholders (developers, QA, data scientists) on CDI logic interpretation Skills & Competencies Expert knowledge of ICD-10-CM/PCS coding conventions In-depth understanding of clinical indicators, pathophysiology, and clinical validation concepts Strong grasp of CC/MCC capture, DRG shifts, SOI/ROM impact, and query compliance Excellent written communication skills for authoring logic documentation and clinical justifications Analytical mindset with ability to think in rules, hierarchies, and logic trees Comfortable working in cross-functional teams including clinicians, product managers, and engineers