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15/06 Reena Gonsalves
Consultant at Innoquest Consulting

Views:72 Applications:16 Rec. Actions:Recruiter Actions:1

Manager - Payer - Claims Adjudication - Provider RCM Operations (8-12 yrs)

Navi Mumbai/Mumbai Job Code: 1111315

MANDATORY ASK:

8-12 YEARS OVERALL EXPERIENCE WITH MIN 4-5 YEARS IN US HEALTHCARE PROVIDER - RCM - PHYSICIAN OR HOSPITAL OPERATIONS EXPERIENCE / OPEN TO WORKING NIGHT SHIFTS (4 PM - 1 PM)

AS A STRATEGIC THINKER:

- Transition Planning and Coordination.

- Identifying Value additions and Process Improvement Initiatives.

- Process Metrics review with the senior management and the team.

- Identifying, recommending, and implementing ways to increase the productivity and the quality of the team.

- Adherence to company policies.

- Ensuring the process meets the defined Service Levels.

- ISO and HIPAA compliance.

AS DRIVING RESULTS:

- Creating Growth Path/Succession Planning for the process.

- Effective Resource Utilization.

- Define and review KRA of Leads, AMs & DMs.

- Manages day to day Operations.

- Timely reporting of deliverables like Performance Incentive, Internal Dashboards.

- Responsible for timely invoicing.

- Attend to Process Escalation and provide effective solutions.

- Responsible for Balance Score Card and its parameters.

- Attend to Client calls, Status Meeting and Client Feedback.

- Review and Regulate SOP.

- Is able to identify problems and take decisions independently.

- Provides solutions to individual and organizational challenges.

AS A PARTNER WITH CLIENTS:

- Co-ordinate on Process Quality requirements.

- Passion for excellence.

- Driving Perfect Service.

- Driving Formula one and other Developmental Programs for the team.

- Identifying, recommending, and implementing ways to increase the productivity and the quality of the team.

LEAD PEOPLE:

- Managing Self.

- Identify and participate in training / developmental programs.

- Inspiring Others / Managing Teams.

- Control Absenteeism and Attrition in the Process.

- Coaches and mentors AMs & DMs.

- Hiring as per the process requirements.

QUALIFICATIONS & MANDATORY SKILLS:

- US health care (ERISA/HIPAA/State Mandates)

- Process SLA

- Awareness of ISO, ISMS

- Telephone etiquettes

- MS office

- Process Knowledge

- Effective communication

- Good analytical skills

- People Management

- Feedback and Counselling

- Presentation

- Coaching and Mentoring

- Graduation/Post Graduation

Women-friendly workplace:

Maternity and Paternity Benefits

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