10 Provider Management Jobs

As a PE-Revenue Cycle Management Specialist, you will be an integral part of our team dedicated to managing and optimizing revenue cycles within the life sciences sector. Your role will involve analyzing and overseeing revenue cycle processes to ensure smooth financial operations. Proficiency in MS Excel and expertise in Accounts Receivables and Provider management are essential for this entry-level position. The position is based in our office and requires night shifts, offering a dynamic work environment. Your responsibilities will include collaborating with team members to identify and resolve discrepancies in accounts receivables, creating detailed financial reports and data analysis using MS Excel, and assisting in developing strategies to enhance revenue collection. Effective communication with internal and external stakeholders, compliance maintenance, and participation in meetings for progress updates and areas of improvement are key aspects of this role. To excel in this position, you should demonstrate proficiency in MS Excel, possess foundational knowledge of accounts receivables processes, understand provider management within the revenue cycle, and showcase strong analytical, problem-solving, communication, and interpersonal skills. Attention to detail, accuracy, and adaptability to night shifts are also crucial. Additionally, holding a Certified Revenue Cycle Specialist (CRCS) or equivalent certification is preferred for this role. Join us in contributing to the continuous improvement of revenue cycle processes and workflows, providing insights based on data analysis, and ensuring accurate documentation and record-keeping for financial transactions. Training new team members on revenue cycle management best practices and maintaining a high level of accuracy in all tasks will be part of your responsibilities.,

Executive-Provider Management Experience: 0.6 -3 Years Exp Salary: 2 to 5 LPA Preferred Notice Period : Within 15 Days Opportunity Type: Office (Bengaluru) Placement Type: Full-time (*Note: This is a requirement for one of Uplers' Clients) Must have skills: Vendor agreements OR Vendor Management AND Reconciliation AND Provider management Practo (One of Uplers' Clients) is looking for: About Us: Practo is a leading healthcare platform that connects patients with healthcare providers around the world. It aims to improve the healthcare experience for millions of people by simplifying appointment bookings, online consultations, digital prescriptions, and medical record management. Practo is on a mission to make healthcare more accessible, simpler and more reliable for everyone. Role Purpose: The main objective of the Executive-Provider Management role is to manage and strengthen the relationship between Practo and healthcare providers to ensure their engagement, satisfaction, and retention. Key Responsibilities & Accountabilities: Responsible for creating and managing an in-house network for AHC and wellness requirements for the specific zone. The candidate will be required to liaise with CXOs of Hospitals, laboratories, diagnostic centres & other healthcare vendors on a periodic basis with the objective of facilitating and managing business relations. The incumbent will also be required to partner with local labs or hospitals across the defined zones. They are expected to be adept at negotiations and relationship management with their stakeholders. Be an interface between the Healthcare vendors and Customer management team to facilitate smooth closure of requests and onboarding. Develop and expand the Medical provider's network to meet the ever-growing customer needs and demands. Responsible for overall activities related with the empanelment of Network Providers Doctors, Laboratories, Hospitals and other wellness partners. Experience in identifying tests, packages and components associated with health check-up packages. Experience in Provider contracting and tariff negotiation on the best available rates for cashless facility along with corporate health check packages. Ensure all signed contracts adhere to the local regulatory and corporate outsourcing guidelines and requirements. Conduct monthly due diligence assessment & Periodic audit of Network providers with random onsite visits. Monitor and ensure business efficiency and appointed Network Providers Service Level Agreements (SLAs) are met. Provide complaint resolution and come up with corrective action in relation to service delivery failure, payment matters with Network Providers. Take ownership of monthly payment reconciliation efforts of the respective vendor accounts. Ensure adequate measures are in place to identify fraudulent activities at providers and take timely action Required Skills/Qualifications: Strong proficiency with MS Excel and MS Powerpoint - Previous experience of managing provider networks. Good communication Skills Vendor Management Bachelor's degree Work Environment/Location: This role is based in our Bengaluru office. It's not remote and requires regular office attendance. As part of the Practo team, you'll work in a fast-paced, dynamic environment where innovation and collaboration are valued. How to apply for this opportunity: Easy 3 Step Process: 1. Click On Apply and register or log in to our portal 2.Upload updated Resume & complete the Screening Form 3. Increase your chances of getting shortlisted & meet the client for the Interview! About Uplers: Our goal is to make hiring and getting hired reliable, simple, and fast. Our role will be to help all our talents find and apply for relevant product and engineering job opportunities and progress in their career. (Note: There are many more opportunities apart from this on the portal.) So, if you are ready for a new challenge, a great work environment, and an opportunity to take your career to the next level, don't hesitate to apply today. We are waiting for you!

Job Title: Senior CSA Job Category: Associate Function/Department: Operations Role Description: Roles & Responsibilities Processing and data entry for routine types of physician and contract linkage transactions such as: Load new physician demographics and contract linkage using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Perform physician demographics and contract linkage data using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Responsible for ensuring all data elements necessary to complete the request are provided and responds to the submitter with a detailed outline if additional information is needed Use desk-top macros whenever possible to ensure data loading accuracy and efficiency Send large requests capable of being automated as defined by management to the AST Provide excellent customer service to customers (physician, health plans, affiliates, delegates, insured, and all associated business partners) by: Quickly and accurately identifying and assessing customer needs and taking appropriate action steps to satisfy those needs Solve problems systematically using sound business judgment and following through on commitments using an automated approach whenever possible Respond to customers in a polite and professional manner Complete assigned work within established TAT and Quality metrics while remaining within downtime parameters to ensure customer satisfaction Key Results Production, Quality Shift and Schedule adherence Process Knowledge Role Holder Profile A. Preferred educational qualifications: Graduation (Any discipline - 3 years) without arrears. B. Preferred work experience: Minimum 6 months to 1 year of experience in Provided Data Management C. Skills and Competencies Mandatory knowledge in health care industry and PDM Working knowledge of systems platforms preferred PC skills (Power Point, Word, Excel, Access, Lotus Notes, Intranet) preferred Strong customer service orientation required i. Functional / Technical: ii. Behavioral: Shift Adherence Floor Decorum Interpersonal skills Team Player

Manager-Segment Incharge The role is responsible for all tasks related to Processing and Settlement of claims, Monitoring TPA performance for the assigned business. The role includes managing the assigned specialized business handling of any one or more of the following activities: Settlement of Claims, Monitoring TPA performance based on defined KPI, System, Development, UAT, Portfolio Analysis, MIS/Compliance. If this is you, we are looking for you! Key Responsibilities Managing end-to-end claims. Requisitioning detailed information on all reported and settled Claims and monitoring performance of TPAs, evaluating performance of all TPA based on parameters of SLA with Regular Review of defined KPIs. Monitoring and performance evaluation of TPA including timely review of TAT & quality for various process followed in TPAs, daily TAT monitoring, escalation & expectations management for specialized business handling of retail portfolio. Maintaining and updating TPA records on daily basis which help us to know the performance of retail policies and portfolio. Conducting QC of reports and data of TPA shared with us on regular intervals to analysis the data on all benefits as per retail policies. Supporting Actions IT Systems Development System development for uploading and extracting TPA claims and generating reports from the same. Cost containment without losing on customer experience, actionable of feedbacks on claims experience. Educational Qualification: - Preferably MBBS, BHMS, BAMS Doctor Minimum 7-9 years in handling similar role Experience in handling provider management (Hospitals and other vendors) is mandatary. Its a urgent opening please share your resume at aparna@aceconsultants.in

Job Title: Business Analyst (Preferably from Healthcare IT domain) Location: Chennai - DLF Job Type: Full Time Experience Level: [Mid-Level / Senior-Level] Department: IT / Healthcare Solutions Job Summary: We are seeking a highly motivated and detail-oriented Business Analyst with strong experience in the Healthcare IT domain . The ideal candidate will bridge the gap between business needs and technology solutions, working closely with stakeholders to define requirements, streamline processes, and implement solutions that support our healthcare initiatives. Required Skills & Qualifications: Bachelors degree in Computer Science, Information Technology, Healthcare Administration, or related field. 510 years of experience as a Business Analyst, preferably in the Healthcare IT domain. Strong understanding of healthcare systems including EHRs/EMRs (e.g., Epic, Cerner), claims systems, and patient management platforms. Experience with Agile, Scrum, or other SDLC methodologies. Excellent communication, documentation, and stakeholder management skills. Proficient in tools such as JIRA, Confluence, MS Visio, Balsamiq, or similar. If interested kindly share your updated CV to priyad@kyyba.com along with the following details, No of years of Experience - Experience in Healthcare IT - Notice Period - How soon can join - Current CTC - Expected CTC -

Greetings!!! Openings at Sagility for Process Trainer(US Healthcare) Minimum of 4 years of experience as a Process Trainer in an International BPO. Excellent written and verbal communication skills, with strong interpersonal abilities. Proven experience as a Trainer in an International BPO environment. Strong presentation and Excel skills. Sound knowledge of basic training methodologies. Ability to work in US rotational shifts. Immediate joiners are mostly preferred. Interested candidates can share your resume to anitha.c@sagilityhealth.com

Job Description: Solicit, review and analyze business requirements Write business and technical requirements Communicate and validate requirements with stakeholders Validate solution meets business needs Work with application users to develop test scripts and facilitate testing to validate application functionality and configuration Participate in organizational projects and/or manage small/medium projects related to assigned applications Translates customer needs into quality system solutions and ensures effective operational outcomes Focus on business value proposition*Apply understanding of 'As Is' and 'To Be' processes to develop solution 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). Role Focus Areas: Core Expertise Required: Provider Management Utilization Management Care Management Domain Knowledge: Value-Based Care Clinical & Care Management Familiarity with Medical Terminology Experience with EMR (Electronic Medical Records) and Claims Processing Technical/Clinical Understanding: Admission & Discharge Processes CPT Codes, Procedure Codes, Diagnosis Codes Job Qualification: Undergraduate degree or equivalent experience. Minimum 5 Years experience in Business Analysis in healthcare including providing overall support, maintenance, configuration, troubleshooting, system upgrades, and more for Healthcare Applications. Good experience on EMR / RCM systems Demonstrated success in running EMR / RCM / UM, CM and DM systems support in requirements, UAT, deployment supports Experience working with stakeholders, gathering requirements, and taking action based on their business needs Proven ability to work independently without direct supervision Proven ability to effectively manage time and competing priorities Proven ability to work with cross-functional teams Core AI Understanding AI/ML Fundamentals: Understanding of supervised, unsupervised, and reinforcement learning. Model Lifecycle Awareness: Familiarity with model training, evaluation, deployment, and monitoring. Data Literacy: Ability to interpret data, understand data quality issues, and collaborate with data scientists. AI Product Strategy AI Use Case Identification: Ability to identify and validate AI opportunities aligned with business goals. Feasibility Assessment: Understanding of whats technically possible with current AI capabilities. AI/ML Roadmapping: Planning features and releases that depend on model development cycles. Collaboration with Technical Teams Cross-functional Communication: Ability to translate business needs into technical requirements and vice versa. Experimentation & A/B Testing: Understanding of how to run and interpret experiments involving AI models. MLOps Awareness: Familiarity with CI/CD for ML, model versioning, and monitoring tools. AI Tools & Platforms Prompt Engineering (for LLMs): Crafting effective prompts for tools like ChatGPT, Copilot, or Claude. Responsible AI & Ethics Bias & Fairness: Understanding of how bias can enter models and how to mitigate it. Explainability: Familiarity with tools like SHAP, LIME, or model cards. Regulatory Awareness: Knowledge of AI-related compliance (e.g., HIPPA, AI Act). AI-Enhanced Product Management AI in SDLC: Using AI tools for user story generation, backlog grooming, and documentation. AI for User Insights: Leveraging NLP for sentiment analysis, user feedback clustering, etc. AI-Driven Personalization: Understanding recommendation systems, dynamic content delivery, etc.

Key Responsibilities: 1. Hospital Visit Management: Conduct regular visits to hospital partners to review and address pricing structures, contract terms, and service quality. Analyze and assess hospital billing and pricing strategies to ensure alignment with organizational objectives. 2. Claims Negotiation: Lead negotiations with hospital partners regarding claims and reimbursement issues to ensure favorable outcomes for the organization. Work closely with the internal claims team to resolve discrepancies and expedite claim resolutions. 4. Pending Issues and Concerns: Identify, track, and resolve pending issues and concerns related to hospital partnerships, including billing disputes, service quality, and contractual obligations. Act as a liaison between the hospital and internal teams to address and mitigate concerns promptly. 5. Coordination with Internal Stakeholders: Collaborate with internal departments to ensure alignment on hospital-related activities and strategies. Facilitate effective communication and coordination between internal teams to address issues and implement solutions. 6. Documentation and Reporting: Prepare and maintain comprehensive documentation of hospital visits, pricing agreements, claims negotiations, and issue resolutions. Document and update sales meetings, including key takeaways, action items, and progress reports. 7. Sales Meeting Coordination: Organize and lead sales meetings to discuss hospital partnerships. Provide regular updates and reports to sales teams and management on hospital-related activities and performance.

Were Hiring: Senior Mobile Developer (React Native) Are you passionate about building seamless, high-quality mobile experiences on both Android and iOS platforms? Join our dynamic team and help shape the future of our mobile applications! What You'll Bring: Bachelors or Masters degree in Computer Science, Engineering, or a related field. 6+ years of hands-on mobile development experience. Proven track record of building and deploying apps on Android and iOS. Expertise in React Native, QuickType, React Context API/Redux, UI Components, and Axios. Experience with state management frameworks like Provider, Riverpod, or BLoC. Strong knowledge of Android SDK, iOS SDK, and platform-specific development nuances. Skilled in integrating mobile apps with REST APIs, Firebase, and cloud services. Proficient with Git and version control workflows. Familiarity with app store submission processes, guidelines, and release management. Excellent analytical and problem-solving skills. A collaborative mindset and ability to thrive in a team environment. Why Join Us? Work on exciting projects that impact millions of users. Collaborative, innovative, and supportive work culture. Opportunities for professional growth and skill development. Ready to take your mobile development career to the next level? Apply now or share with someone who would be a perfect fit!

Greetings!!! Openings at Sagility for Process Trainer-Enrollment(US Healthcare) Minimum of 4 years of experience as a Process Trainer in an International BPO. Excellent written and verbal communication skills, with strong interpersonal abilities. Proven experience as a Trainer in an International BPO environment. Strong presentation and Excel skills. Sound knowledge of basic training methodologies. Ability to work in US rotational shifts. Immediate joiners are mostly preferred. Interested candidates can share your resume to anitha.c@sagilityhealth.com