Senior Program Manager

Job Description

About the role: Needs to work closely and communicate effectively with internal and external stakeholders in an ever-changing, rapid growth environment with tight deadlines. This role involves designing and analyzing the healthcare reimbursement model . Be able take up new initiatives, maintain synchrony in the team. Collaborate with external & internal stakeholders, work effectively in a growing team, be a strong team player. Be able to create and define SOPs, TATs for ongoing and upcoming projects. What you will do: To design, analyze and maintain healthcare reimbursement models to ensure the revenue estimation is in-line with the contracts. To perform various analytical reviews and deep-dives (root cause analysis) on client-specific healthcare reimbursement methodologyto ensure accuracy of revenue projections and actual collections. To report/highlight the exceptions in reimbursement method by building contract models for Hospital charges To effectively communicate the findings/ observations with recommended action to US team/clients. Maintain MIS related to analysis, Accuracy and coverage report for maintenance databases Handling client calls and communicating effectively for task deliverables and site maintenance What will you need: Graduate degree Preferably in Statistics\Mathematics\Economics\Commerce\Finance from a reputed educational institute Good analytical and algorithm building skills, having experience to build contract models for hospital charges to calculate expected reimbursement Skills to read, understand and interpret reimbursement contracts between hospitals and insurance providers. Experience/knowledge of various US healthcare reimbursement methods like MS DRG weightage, Multipliers, % of charges, outliers, Grouper fee schedule etc. Good Communication Skills (both written & verbal) Preferable - 1-3 years of experience in US healthcare Having good knowledge about RCM cycle and denial management