AGM/DGM - Revenue Cycle Management Operations - US Healthcare/Provider

POSITION OVERVIEW:

The Purpose of the Position is to Provide operational guidance, value creation and help deliver customer expectations as defined as per SLA, identify areas for improvement and develop strategies to achieve the contractual metrics and relevant Operational standard for Provider / RCM Operations [ ex. HFMA standards].

The Revenue Cycle Management Operations role involves overseeing the entire revenue cycle process, from patient registration and billing to claims processing and collections, with the goal of maximizing revenue and ensuring financial stability.

KEY POSITION RESPONSIBILITIES:

1. Exceptional in RCM domain and understands the delivery and solutions landscape in RCM domain.

2. Manage projects related to Provider Operations/ RCM, including system enhancements, process improvements, and data migration initiatives.

3. Develop and implement data governance strategies and policies to ensure consistent and standardized management of provider data across the organization. Establish data quality metrics and monitor data accuracy and completeness.

4. Collaborate with internal stakeholders, including contracting, network management, claims, and other departments, to ensure accurate provider data for operational and reporting needs. Address and resolve provider data-related issues and inquiries.

5. Ensure compliance with federal, state, and local regulations related to healthcare RCM, including but not limited to HIPAA, HITECH Act, NSA, and ACA.

6. Develop and maintain performance metrics and key performance indicators (KPIs) for Provider Operations/ RCM operations. Prepare and present regular reports on data accuracy, timeliness, and process efficiency to management.

QUALIFICATIONS & REQUIREMENTS:

1. Bachelor's degree in healthcare administration, business administration, or a related field. A master's degree is preferred.

2. An overall U.S healthcare experience between 10-16 years with extensive operational experience (typically 5-10 years in RCM) Provider Operations/ RCM or a related field.

3. Excellent collaboration and influencing skills and ability to work in a metricized organization.

4. Strong leadership and managerial skills with a proven track record of successfully leading and developing high-performing teams.

5. 3-10 years' experience on Service Delivery Transformation (RPA/ Robotics) areas in RCM BPM Services. in addition to being well versed in the current Provider Solutions healthcare literature.

6. Excellent analytical, problem-solving, and decision-making abilities.

7. Exceptional communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders.

8. Strong understanding of compliance requirements and experience in ensuring adherence to regulations.

9. Proficiency in using RCM software, data analysis tools, and Microsoft Office Suite.