Remote RCM Quality and Outcome Improvement Analyst

Summary

Join a team of passionate problem-solvers on a mission to modernize healthcare by placing doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. As a key position within Modmed India Operations, you will play a critical role in meeting productivity targets, delivering customer service, and ensuring ModMed's overall service delivery is consistently maintained at the highest standards.

Responsibilities

• Play a critical role in meeting productivity targets
• Delivering a high level of customer service
• Ensuring ModMed's overall service delivery is consistently maintained at the highest standards
• Identifying and addressing opportunities to improve workflows
• Reducing non-meaningful touches by analyzing trends on inflows of claim-level assignments
• Set up and manage online portals following the requirements and payer details provided by global partners
• Work claims escalated from global partners, practices and onshore teams as per Standard Operating Procedures (SOPs)
• Review claims assigned to practice for quality and determine if decision tree enhancements will prevent future escalation of a similar claim
• Analyze Dashboards/Reports for production and AR trends to identify quality issues; sample the claims and fill out Quality Analysis forms
• Run reports regularly and maintain a status tracker to keep a close eye on various inventories
• Closely review the Practice Instructions (client specific requirements) and bring any opportunities to enhance and update to onshore RCM Client Advisors
• Review KPIs and other important matrix data to ensure the allocated practices are green and have an “A” on the health scorecard
• Review Jira tickets created by RCM Client Advisors and global partners for timely resolution; analyze ticket trends to recommend fixes to reduce ticket traffic
• Present and review trends, issues and observations with RCM Client Advisors and join respective practice and vertical calls when appropriate
• Analyze all functions of practice escalations and contribute to the plans of action shared by global partners and ensure any concerns to meet the plan are addressed
• Regularly review SOPs to ensure workflows are being followed as documented and any new opportunity is identified where workflows can be improved
• Work closely on new implementations to identify knowledge transfer challenges and audit the work before it is released
• Assist in monitoring of Service Legal Agreements (SLA) by our global partners as well as internal teams
• Perform additional projects and job duties as assigned