Remote RCM Quality and Outcome Improvement Lead

Summary

Join a dynamic team of 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 Supervisor, RCM Quality and Outcome Improvement (QOI), you will lead a team of analysts in delivering high-quality services while ensuring compliance with ModMed's billing and procedures.

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

Responsibilities

• 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

Benefits

• 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
• Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution
• 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep
• Generous Paid Time Off and Paid Parental Leave programs
• Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs
• Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed
• Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning
• Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles
• Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters