RCM Quality Assurance Specialist

1 month ago

Hyderabad, India ModMed Full time

At Modernizing Medicine, we look for passionate, innovative, creative Rock Stars

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 South Florida Business Journal, Best Places to Work 2021

Who we are:

We Are Modernizing Medicine (WAMM) We’re a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started ModMed is based in Boca Raton, FL, with office locations in Santiago, Chile, Berlin, Germany, Hyderabad, India, and a robust remote workforce with team members across the US.

The RCM Quality Assurance (QA) Specialist will be responsible for auditing the work of RCM analysts to ensure the highest standards of services are delivered. They will play a pivotal role in identifying process gaps and work closely with onshore and offshore teams to define SOPs and decision trees that will improve the process. 

The Role:

Apply quality assurance expertise by closely monitoring trends, identifying transactions and processes for audits, presenting audit outcomes and recommendations to mitigate gaps to the operations team for resolution. Utilize tools and technologies available to ensure quality concerns are proactively identified and corrected. Work closely with operational teams to resolve process ambiguity by calibrating on audit process and parameters. Ensure Standard Operating Procedures (SOPs) and client specific practice instructions are followed and report any gaps identified with recommendations for improvement.  Continuously improve the quality processes by suggesting innovative ways quality concerns can be quickly identified, fixed and monitored to avoid recurrence. Actively monitor for compliance as per HIPAA guidelines and report any incidence of non-compliance. Actively participate in quality and training huddles, create content, and deliver necessary training to resolve identified skill or knowledge gaps on the team. Audit for adherence to SOPs and other guidelines and provide references and feedback. Review customer feedback/concerns and ensure that corrective action is being taken, adhering to the plan of action. Provide feedback on SOPs so that the processes and procedures are created in such a way that these can be implemented most effectively. Propose changes in decision trees through which inefficiencies and redundancies can be eliminated. Participate and contribute to the success of new clients by identifying any bottlenecks during implementations. Provide training and guidance to team members to improve their knowledge and skills so they are sufficiently equipped to deliver best in class services. Collaborate with the onshore quality team to ensure consistency on processes and procedures being followed across Modmed locations.  Perform additional projects and job duties as assigned.

Skills & Requirements:

Bachelor's Degree -Bachelor’s preferably in Human Science / Commerce/ Business Administration preferred  Certification in Quality Improvement and Assurance 5+ years of relevant working experience in core Provider RCM out of which minimum 2 years as SME, QA, QA Lead, etc. within a professional setting. Hands-on knowledge of the key functions within RCM is a must. Prior experience of working on Modmed products is a plus.  Experience working on process improvements/ six sigma quality projects preferred.  Proven knowledge of various insurance carriers, including Medicare, private HMOs, PPOs, Capitation and Workers’ Comp. etc. 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 validation functions, able to create visualizations of data through charts, graphs and powerpoint; able to manage information located in multiple software systems. Exceptional written, verbal, and interpersonal communication skills required. Committed to developing expertise in respective ModMed products (PM or gPM) within 3 months of employment. Professional demeanor, team player, strong time management skills required. Able to work during US night shifts within a hybrid work model from home and office is required - this position requires working closely with onshore/offshore teams, as well as with payer reps.

ModMed in India Benefit Highlights:

High growth, collaborative, transparent, fun, and award-winning culture Comprehensive benefits package including medical for you, your family, and your dependent parents. The company supported community engagement opportunities along with a paid Voluntary Time Off day to use for volunteering in your community of interest Global presence, and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office based roles and remote availability,  Company-sponsored Employee Resource Groups that provide engaged and supportive communities within ModMed

ModMed Benefits Highlight:

At ModMed, we believe it’s important 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, including a company Health Savings Account contribution, 401(k) Plan with immediate vesting in the company matching contribution, Generous Paid Time Off and Paid Parental Leave programs, Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs, Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed, Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning, Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability, Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.

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