Quality & Outcome Improvement Analyst

2 weeks ago

hyderabad, India Michael Page Full time
High growth, collaborative, transparent, fun, and award-winning culture Comprehensive benefits package including medical for you, your family,

About Our Client

leading Health-Tech clients which offers electronic health records, practice management, revenue cycle management and data analytics for doctors, and currently has software for dermatologists, orthopaedic surgeons, gastroenterologists, plastic surgeons, otolaryngologists, urologists and pain management physicians.

Some of their key highlights being-
· South Florida Business Journal, Best Places to Work 2024
· Inc. 5000 Fastest-Growing Private Companies in America 2023
· Company of the Year | 2023 BIG Innovation Awards
. Fastest-Growing Company of the Year - Large (Bronze) | 2022 Best in Biz Awards

Job Description

Play a critical role in meeting productivity targets, delivering a high level of customer service, and ensuring overall service delivery is consistently maintained at the highest standards while ensuring ModMed's billing and compliance processes and Standard Operating Procedures (SOPs) are followed.
* Responsible for identifying and addressing opportunities to improve workflows and reduce non-meaningful touches by analysing trends on inflows of claim-level assignments.
* Set up and manage online portals following the requirements and payer details provided by global partners, including, but not limited to, creating W9 forms and following up with payers.
* Work claims escalated from global partners, practices and onshore teams as per Standard Operating Procedures. (SOPs). Including but not limited to:
* Analyze claims addressed for credentialing issues from global partners and work closely with onshore to resolve credentialing issues.
* Review claims assigned to practice for quality and determine if decision tree enhancements will prevent future escalation of a similar claim.
* Analyze Dashboards/Reports for production and AR trends to identify quality issues; sample the claims and fill out Quality Analysis forms.

The Successful Applicant

5+ years of related working experience in core Provider RCM out of which minimum 2 years as SME, Asst. Team Lead, Team Lead , QA, QA Lead, etc. within a professional setting.
* Strong understanding of RCM Processes and best practices - knowledge at a transaction level is required.
* Experience working on process improvements/ six sigma quality projects preferred.
* Proven expertise in the front-end and back-end functions of the provider side of US Healthcare RCM such as charges, payment posting , AR follow ups, denials, eligibility, etc.
* Comprehensive understanding of the full revenue cycle process for claim submission, medical insurance policies, and ICD-10 and CPT coding guidelines.
* Proven knowledge of various insurance carriers, including Medicare, private HMOs, PPOs, Capitation and Workers' Comp.
* Advanced excel skills such as the ability to use formulas to analyze data, create and format pivot tables and templates, use and conditional formatting and validationWilling to work in US shifts, 5 days WFO

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