RCM Performance Optimization Specialist

5 days ago


Hyderabad, Telangana, India ModMed Full time

About the Role:

ModMed is seeking a skilled RCM Quality and Outcome Improvement Analyst to join our team in India. As a key member of our operations team, you will be responsible for analyzing claims escalated by practices or global partners and identifying opportunities to improve process efficiency.

Your Responsibilities:

  1. Play a critical role in meeting productivity targets, delivering high-quality customer service, and ensuring ModMed's overall service delivery is consistently maintained at the highest standards.
  2. Identify and address opportunities to improve workflows and reduce non-meaningful touches by analyzing trends on inflows of claim-level assignments.
  3. Set up and manage online portals following the requirements and payer details provided by global partners.
  4. Work claims escalated from global partners, practices, and onshore teams as per Standard Operating Procedures.
  5. Run reports regularly and maintain a status tracker to keep a close eye on various inventories to ensure global partners are working on claims timely.
  6. Closely review Practice Instructions (client-specific requirements) and bring opportunities to enhance and update to onshore RCM Client Advisors.
  7. Review KPIs and other important matrix data to ensure allocated practices are green and have an 'A' on the health scorecard.
  8. Review Jira tickets created by RCM Client Advisors and global partners for timely resolution.

Requirements:

  • 5+ years of related working experience in core Provider RCM, with a minimum of 2 years as SME, Asst. Team Lead, Team Lead, QA, QA Lead, etc.
  • Strong understanding of RCM Processes and best practices.
  • Experience working on process improvements/six sigma quality projects preferred.
  • Proven expertise in front-end and back-end functions of the provider side of US Healthcare RCM.
  • 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.
  • Exceptional written, verbal, and interpersonal communication skills.

About ModMed:

At ModMed, we believe it's essential to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits, including comprehensive medical, dental, and vision benefits, a 401(k) Plan with immediate vesting in the company matching contribution, and generous Paid Time Off and Paid Parental Leave programs.



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