RCM Quality and Outcome Improvement Lead

The Supervisor, RCM Quality and Outcome Improvement (QOI)  is a leadership position within Modmed India Operations to supervise a group of analysts deployed for multiple practices preferably within a single vertical/specialty. They will be responsible for the day-to-day deliverables for their team along with enhancing the collaboration and partnership between internal and vendor teams. They will ensure that team goals are met while continuously developing their team members’ knowledge and skills, as well as their own.  The position will report to the Modmed India QOI Senior Manager.  If you have experience in and passion for RCM Quality Improvement and treat your team members as the greatest asset, please apply!

The Role:

• Play a critical leadership role in ensuring day-to-day operations are running smoothly, productivity targets are met, a high level of customer service is delivered, and overall service delivery is consistently maintained at the highest standards while ensuring ModMed’s billing and compliance processes and Standard Operating Procedures (SOPs) are followed. 
• Help the team to prioritize their work and understand the critical importance of following SOPs and communicating challenges and findings to their supervisor in a timely manner.
• Inform leadership of critical findings impacting RCM performance and recommend solutions to improve outcomes. 
• Work closely with the internal and external teams ensuring challenges and findings raised by analysts are documented, actioned upon and converted to wins within set timelines.
• Collaborate with onshore and offshore training teams to create and deliver vertical-focused knowledge to team members.
• Review the Practice KPI Trends and work with the team to identify and resolve issues promptly and thoroughly.
• Partner with onshore and offshore teams on creating and implementing process and procedure for identifying and permanently resolving quality concerns and plans of actions (POA) for client escalations. 
• Work with onshore vertical teams on standardizing the processes and practice instructions. 
• Share monthly trend analysis at practice level to identify continuous improvement opportunities.
• Participate in process improvement discussions and help ensure necessary conversion to SOPs.
• Closely monitor new client implementations to identify any challenges while simultaneously working with onshore and offshore teams to ensure required knowledge is shared across teams.
• Work with onshore coordinators to resolve any open issues impacting performance and quality.
• Perform additional projects and job duties as assigned.

Skills & Requirements:

• Must have strong, hands-on-knowledge  of all the functions within Physician RCM of US Healthcare.
• 7+ years of related working experience in core Provider RCM, out of which minimum 2 years as a Lead Operations / QA/ Process Improvement managing a team of 10-20 FTEs.
• Strong knowledge of workflows and procedures within specialities such as Dermatology, Gastro, Orthopedics, Podiatry, Ophthalmology, ENT,  etc.,  is a big plus.
• Adept at developing and analyzing various KPIs/other trends while running the reports from various sources. 
• Exceptional written, verbal and interpersonal communication skills required; working closely within a collaborative environment having multiple onshore and offshore teams. 
• Strong understanding of various insurance carriers, including Federals, HMOs, PPOs, Capitation and Workers’ Comp
• 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 PPTs using MS Office and other tools.
• A six sigma specialist who has participated in process and quality improvement projects is preferred. 
• Proven experience and commitment to actively promoting a positive work environment and developing an employee-focused, supportive workplace aligning to ModMed’s culture. 
• Must be committed  to developing expertise in respective ModMed products (PM or gPM) within three months of employment. 
• Able to work during US Day  within a hybrid work model  from home and office as per the needs of the Company  is imperative - This position requires working interactively with onshore / Offshore Teams.

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

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