Operations [RCM]
Job Role
We are seeking an experienced Assistant Manager to join our US Healthcare Revenue Cycle Management (RCM) team. The ideal candidate will have in-depth knowledge of the US healthcare RCM business, strong expertise in healthcare claims denials, and excellent analytical skills. This is an individual contributor role, where the candidate will play a pivotal role in identifying, resolving, and preventing claim denials while ensuring high-quality outcomes for clients. A deep understanding of healthcare claims, denial management, root cause analysis, and proficiency in Excel and Power BI is essential for success in this role.
- RCM Expertise: Manage and oversee US healthcare RCM denial management, and accounts receivable follow-up.
- Claims Denials & Resolution: Take ownership of analyzing denied claims, identifying root causes, and implementing effective resolution strategies.
- Root Cause Analysis: Analyze patterns and trends in denials and rejections, and drive continuous improvement initiatives to prevent future occurrences. Provide detailed insights and reports on denial reasons and recommend corrective actions.
- Analytical Support: Use advanced analytical skills to evaluate claims data, identify gaps in the RCM process, and drive data-driven decisions to improve operational efficiency and client satisfaction.
- Reporting & Insights: Leverage Excel and Power BI to generate comprehensive reports and dashboards, presenting actionable insights on denial trends, claim performance, and overall process effectiveness.
- Individual Contributor: Work independently to manage day-to-day RCM activities, ensuring adherence to timelines, SLAs, and quality standards.
- Collaboration: Work closely with cross-functional teams such as billing, coding, and operations to address denial issues, improve workflow processes, and enhance claim resolution turnaround times.
- Process Improvement: Lead and participate in continuous process improvement initiatives aimed at optimizing RCM operations, enhancing productivity, and minimizing errors and rework.
Candidate Requirements
- Experience: Minimum of 7 years of experience in the US healthcare RCM industry with a strong focus on claims management, denial resolution, and root cause analysis.
- Proficiency: Highly proficient in Microsoft Excel (advanced formulas, pivot tables, VLOOKUP, etc.) and exposure to Power BI preferred. Ability to create reports, dashboards, and actionable insights from data.
- Denial Management: In-depth knowledge of healthcare claims denials, their resolution processes, and strategies for identifying root causes and improving denial rates.
- Analytical Skills: Excellent analytical and problem-solving abilities with a data-driven mindset to understand trends, identify gaps, and optimize processes.
- Communication Skills: Strong verbal and written communication skills, with the ability to present complex data and insights clearly and concisely to stakeholders.
- Attention to Detail: High attention to detail, with the ability to identify discrepancies, inconsistencies, and errors in claims data.
- Self-Motivated: Ability to work independently, manage priorities effectively, and drive results with minimal supervision.
- Education: Bachelor’s degree in Healthcare Management, Business Administration, Finance, or a related field is preferred.
- Experience with Tools: Experience working with RCM software, claim management systems, and knowledge of various payer requirements (e.g., Medicare, Medicaid, Commercial payers).
- Experience with Excel and PowerBi: Knows advance excel, formulas, Data interpretation from PowerBi