Plutus Health Inc. is seeking a skilled EDI Consultant with specialized experience in healthcare claim transactions to support our Data Integration (DI) Review & Validation efforts. The ideal candidate will have a strong background in 837P professional claim formats and CMS-1500 form mappings, with the ability to assess and validate system logic against payer-specific requirements. Key Responsibilities: Conduct detailed reviews of 837P (Professional) EDI transactions to ensure data integrity and format accuracy. Validate mappings to CMS-1500 claim forms , ensuring alignment between electronic and paper-based formats. Review and confirm correct population of provider fields (e.g., Rendering NPI, Supervising NPI ) at both line-item and claim levels . Identify, document, and communicate any gaps, mismatches, or inconsistencies between system-generated data and payer requirements. Collaborate with cross-functional teams (EDI developers, business analysts, QA) to provide feedback and recommend corrections. Participate in user acceptance testing (UAT) and post-deployment validation to ensure implementation success. Stay updated on HIPAA EDI standards and payer-specific guidelines related to 837P/CMS-1500 submissions. Required Qualifications: Proven experience working with 837P transactions and CMS-1500 claim formats. Strong understanding of HIPAA EDI standards , claim data elements, and provider field logic. Hands-on experience with claim validation tools, EDI mapping, and system configuration review. Familiarity with payer-specific submission requirements and business rules. Ability to analyze large data sets and identify discrepancies or issues efficiently. Excellent documentation, communication, and collaboration skills. Preferred Qualifications: Experience with clearinghouses or payers. Familiarity with 837I or other transaction sets (e.g., 835, 999, 277CA). Prior work with EHR/EMR or billing system integrations.
Chief of Staff – India Location: Bengaluru / India Reports to: CEO About Plutus Health Plutus Health Inc. is an Inc 5000, SMU Dallas 100 Fastest growing, EY Entrepreneur of the year Southwest Finalist. We are a tech enabled healthcare revenue cycle management outsourcing firm that has been in the industry for 17 years. We offer end-to-end business solutions to Enterprise healthcare providers in the United States, ensuring that all our services are fully compliant with HIPAA regulations. We are a leading provider of tech-enabled Revenue Cycle Management (RCM) solutions for healthcare providers, with 1,600+ employees across the US and India . Role Overview The Chief of Staff—India is a strategic and operational leader partnering closely with the CEO to drive priorities, lead key projects, coordinate global operations, and foster performance and culture across India and the broader Plutus Health network. This role is the central point between the India executive team and CEO, ensuring seamless execution of both local and global strategies. Key Responsibilities & KRAs 1. Strategic Planning & Execution · Partner with CEO and India management to implement Plutus Health’s vision using proven project management and change acceleration techniques. · Translate global objectives into actionable initiatives for India teams; regularly track, report, and recalibrate execution as needed. 2. India Operations & Leadership · Oversee end-to-end execution of RCM projects, automation, process improvement, compliance, and operational performance with a sharp India market focus. · Lead cross-functional teams (claims, denials, tech, client services), ensuring high-quality and efficient delivery in a rapidly-scaling environment. 3. Cross-Border Integration & Global Support · Facilitate collaboration and alignment between US and India operations, bridging cultural and business practices to optimize global workflows. · Represent India offices in global strategy sessions and proactively raise India-specific needs, challenges, and opportunities. 4. Executive & Stakeholder Communication · Serve as the India-based advisor and gatekeeper to the CEO, prioritizing information and initiatives for executive attention. · Prepare executive briefings, board packs, and key internal/external communications on behalf of the CEO and India leadership. 5. Talent, Culture & Change Management · Drive talent planning, workforce development, skill-building, and cultural initiatives across India. · Foster a high-performance, collaborative, and innovative culture that bridges India and global best practices. 6. Risk, Compliance & Reporting · Track and report KPIs on RCM performance, project delivery, client satisfaction, and workforce engagement. · Assure India operations meet regulatory and contractual obligations, and proactively mitigate operational or compliance risks. Qualifications · Master's degree / MBA in business, healthcare admin, operations, or related field from a Premier university ( IIT/IIM/REC or similar) · 8 + years’ experience in US healthcare RCM outsouricng, IT Services or Technology outsouricng , BPO or similar operations, including leadership roles in India/global settings. . Strong understanding of AI, Automation, Analytics · Demonstrated ability to lead, motivate, and influence teams in a cross-cultural, multi-country business. · Strong project management, process improvement, and data-driven problem-solving skills. · Excellent communication, executive presence, and cultural fluency related to both Indian and Western business environments. Plutus Health Offers · Direct impact on India and global strategy at a growth-focused RCM leader. · High-visibility executive role, career advancement, and cross-border networking opportunities. · Inclusive, tech-driven workplace and competitive total rewards.