Urgent Search Senior Manager

23 hours ago

Chennai India EXL Full time

Job Description

Job Description & Skills Requirements

Job Name:

Manager

Position Title

Senior Manager

Band

C2

Role: Managment

Reporting To

AVP / Sr. AVP

Location/Site:

EXL India

Overview: Senior Manager is responsible for leading strategic initiatives that ensure accurate and appropriate healthcare payments. This includes leveraging advanced medical coding analysis, enforcing policy adherence, and driving overpayment recovery programs. The role plays a critical part in identifying automation and digitalization opportunities to streamline coding processes and enhance operational efficiency.

Qualifications: Bachelor's Degree B.sc/M.Sc./Nursing/Pharmacy/Biotech

Certifications

- CPC/COC - Certified Professional / Outpatient coder
- CCS - Certified Coding Specialist
- CIC - Certified Inpatient Coder

Experience

Sr. Manager: 12 to 18 years experience in medical coding, auditing and automation.

Skills And Abilities

- Advanced knowledge of medical coding software platforms (e.g., 3M Code Finder, Optum360, True Code, Epic, Cerner, etc.).
- Minimum 12 years of hands-on experience in multispecialty medical coding.
- Knowledge of automation tools is an added advantage.
- Payer experience is an added advantage.
- Expertise in Microsoft outlook/excel/word/Power BI.
- Analytical skills
- Team management
- Program management TAT, escalations, Quality
- Strategic thinking / decision making
- Cost management GM, GC, RPE

Primary Roles and Responsibilities:

- Strategic leadership:

Client Market share analysis & strategy to hold more shares by conducting opportunity analysis & planning.

- Prepare and present reports on new finding opportunities financial impacts and existing High and low finding opportunities to leadership.
- Digital: Design and lead initiatives to optimize claims processing and identify fraud, waste and abuse.
- To identify and implement automation and digital transformation to enhance organizational growth.
- Leverage advanced analytics to identify overpayments.
- Explore and implement AI/ML solutions for fraud detection and claim validation.
- Team management: Lead team of SMEs, AMs and Managers, providing mentorship, performance reviews and training.
- Cross-functional collaboration: collaboration with clinical operations, coding operations, quality, repricing, training, digital, IT and technology to align with organizational growth.
- Interface with onshore and clients to resolve disputes and explain audit findings.
- Data and Reporting: Analyze large data sets to detect aberrant payment patterns and coding patterns / trends. Prepare and maintain SOPs & Audit manuals wherever necessary.

Additional Roles and Responsibilities:

- Handle Think team which has subject matter experts
- Oversee Think operations of payment integrity.
- Manage staffing, scheduling, and resource allocation
- Stay updated on changes in healthcare.
- Develop and implement quality improvement initiatives.
- Strategic planning process to align organizational goals.
- Engage in market analysis to understand the competitive landscape.
- Maintaining SOP and Audit manual.
- Track key performance indicators (KPIs).

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