RCM Performance Optimization Specialist
5 days ago
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:
- 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.
- Identify and address opportunities to improve workflows and reduce non-meaningful touches by analyzing trends on inflows of claim-level assignments.
- Set up and manage online portals following the requirements and payer details provided by global partners.
- Work claims escalated from global partners, practices, and onshore teams as per Standard Operating Procedures.
- 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.
- Closely review Practice Instructions (client-specific requirements) and bring opportunities to enhance and update to onshore RCM Client Advisors.
- Review KPIs and other important matrix data to ensure allocated practices are green and have an 'A' on the health scorecard.
- 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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