RCM Quality and Outcome Improvement Analyst
English
₹15000/MONTH
5 Year
Bachelor's degree
Work From Office
Date Posted
26-Feb-2025
Location
Telangana (TG), 1
Job Type
Full Time
Company
Medifast
Description
RCM Quality and Outcome Improvement Analyst
???? Location: Hyderabad, Tamil Nadu | Shift: Night Shift (US Time Zone)
???? Type: Full-time | Work-from-home option available
???? Benefits: Health Insurance | Paid Vacation
About Us – Modernizing Medicine (ModMed)
???? Awards & Recognition:
✔ Best Places to Work 2024 – South Florida Business Journal
✔ Inc. 5000 – Fastest Growing Private Companies in America
✔ #1 EHR in 11 Specialties – 2024 Black Book Awards
✔ Gold in Web-based Digital Health – 2024 Spring Digital Health Awards
✔ 2024 Stevie American Business Award (Silver)
At Modernizing Medicine (ModMed), we are a team of passionate problem-solvers committed to transforming healthcare through intelligent, specialty-specific cloud platforms. Our mission is to improve medical practice success and enhance patient outcomes.
???? Global Presence: Offices in Boca Raton (HQ), Santiago, Berlin, Hyderabad, and a robust remote workforce across the US.
Role Overview
The RCM Quality and Outcome Improvement Analyst plays a crucial role in analyzing, improving, and optimizing revenue cycle management (RCM) workflows. You will work closely with global partners, specialty leads, and onshore teams to enhance claims processing efficiency, compliance, and overall service delivery.
???? If you have expertise in US healthcare RCM, claims processing, and quality analysis, this role is for you!
Key Responsibilities
???? Claims & Quality Analysis
✔ Work on claims escalated by practices, global partners, and onshore teams per SOPs.
✔ Analyze credentialing issues and collaborate with onshore teams for resolution.
✔ Review claims quality, identify gaps, and enhance decision trees to prevent future escalations.
✔ Audit claims and fill out Quality Analysis forms to identify and resolve quality issues.
✔ Monitor practice escalations, ensure timely action plans, and address concerns.
???? Process Improvement & Reporting
✔ Identify workflow gaps and recommend process efficiency improvements.
✔ Analyze claims inflow trends and suggest ways to reduce non-meaningful touches.
✔ Maintain and track production and AR dashboards, ensuring claims are processed on time.
✔ Review practice-specific requirements and suggest updates to RCM Client Advisors.
✔ Conduct regular SOP reviews to optimize workflows and compliance.
???? Communication & Collaboration
✔ Work closely with RCM Client Advisors to discuss trends, issues, and solutions.
✔ Attend practice and vertical calls, contributing insights on escalations and process improvements.
✔ Manage Jira tickets, analyze trends, and recommend fixes to reduce ticket volume.
✔ Collaborate with onshore and offshore teams, payers, and internal stakeholders.
???? Compliance & Service Agreements
✔ Ensure adherence to SOPs, billing compliance, and ModMed’s policies.
✔ Support global partners and teams in monitoring Service Level Agreements (SLAs).
✔ Audit new implementations, identify knowledge transfer gaps, and verify accuracy before release.
✔ Assist in setting up and managing online payer portals per global partner requirements.
Qualifications & Skills
???? Education & Experience
✔ 5+ years of experience in Provider RCM (at least 2 years as SME, Team Lead, QA Lead, etc.).
✔ Deep understanding of RCM processes, claim submission, ICD-10 & CPT coding, and US healthcare policies.
✔ Experience with Medicare, HMOs, PPOs, Capitation, and Workers' Compensation.
✔ Strong data analysis, reporting, and workflow optimization skills.
???? Technical Skills
✔ Advanced Excel skills (pivot tables, conditional formatting, data visualization).
✔ Proficiency in RCM software, analytics tools, and Jira ticketing system.
???? Soft Skills
✔ Excellent communication skills (written & verbal).
✔ Strong problem-solving abilities and attention to detail.
✔ Ability to work independently and collaborate with global teams.
???? Other Requirements
✔ Commitment to learning ModMed products (PM or gPM) within 3 months.
✔ Comfortable working night shifts (US time zone) and coordinating with offshore/onshore teams.
Why Join Us?
???? Competitive Benefits & Perks
✔ Health, dental, and vision insurance (with company HSA contribution).
✔ 401(k) matching – 50% on up to 6% of salary, 100% vested after one year.
✔ Paid Time Off & Parental Leave.
✔ Company-paid Life & Disability Insurance.
???? Career Growth & Learning
✔ Tuition reimbursement & access to LinkedIn Learning.
✔ Professional development programs.
???? Inclusive & Collaborative Work Culture
✔ Diversity-focused employee resource groups.
✔ Flexible work options – Remote, Hybrid, or Office-based.
✔ In-person collaboration & global networking opportunities.
???? Unique Workplace Benefits (US HQ)
✔ Dog-friendly office.
✔ Catered meals, treadmill workstations, and wellness rooms.
Join Us & Be Part of a Mission-Driven Team!
At ModMed, we are committed to diversity, inclusion, and innovation. If you’re looking for a fast-growing company with cutting-edge technology and meaningful impact, apply today! ????
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