Experience and Qualifications:

- 14+ years experience in the US Healthcare domain with 8+ years in US Healthcare RCM Quality.

- Should have in-depth understanding of all functions of Revenue Cycle Management (PP, Billing, AR etc.)

- Graduate/Post Graduate degree.

- Good knowledge on billing nuances, payer rules & guidelines, edits & rejections, billing platforms

- Experience in Six Sigma (Black Belt), ISO, Lean will be an added advantage.

Key Responsibilities:

- Develop a strong and high performing team that ensures superior quality of work for customers

- Lead quality reviews with all stakeholders such as operations, clients, senior management - Align quality to customer requirements and ensure we are measuring quality the same way

- Work with operations and training to lead comprehensive action plans to improve quality - this should include but not limited to Pareto, top error trends, top defaulters, refresher training plan

- Identify areas to be tracked in RCM that will help drive more cash collections

- Identify & lead process improvement initiatives that drive business value

- To advise on the norms required to maintain Quality Standards as per the SLA

- Provide detailed assessments of revenue cycle processes with a focus on positive outcomes through process improvement, training and cost savings

- Provide subject matter expertise in transforming the revenue cycle processes to increase cash flow, by minimizing inventory for each work function by performing root cause analysis

- Should continuously look for trends to fix global issues

- Drive standardized best practices on quality monitoring, feedback process across all RCM functions

- Plan and coordinate resources for new accounts

- Review the performance of different processes regularly with the team and with Ops leaders

- To initiate remedial action in the form of feedback and action plans, resulting in improved efficiency.

- To be able to effectively use the QC tools whenever required to measure, monitor and help improve performance

- Train the team members on usage of the different Quality methodologies to maximize performance

- Should be able to conduct reviews with clients and lead all client reviews

- To be able to identify process gaps and initiate discussions with the client and should be able to effectively articulate the benefits

- Should be able to identify and suggest automation opportunities.

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