Senior Program Manager

3 weeks ago

Gurugram, India R1 RCM Full time

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

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