Senior RCM Quality and Outcome Improvement Analyst

Essential Duties and Responsibilities:

1. Play a critical role in meeting productivity targets, delivering a high level of customer service, and ensuring ModMed’s 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. 
2. Responsible for identifying and addressing opportunities to improve workflows and reduce non-meaningful touches by analyzing trends on inflows of claim level assignments.
3. Set up and manage online portals following the requirements and payer details provided by global partners, including, but not limited to, creating W9 forms and following up with payers. 
4. Work claims escalated from global partners, practices and onshore teams as per Standard Operating Procedures. (SOPs).  Including but not limited to:
5. Run reports regularly and maintain a status tracker to keep a close eye on various inventories to ensure global partners are working on the claims timely.
6. Closely review the Practice Instructions (client specific requirements) and bring any opportunities to enhance and update to onshore RCM Client Advisors.
7. Review KPIs and other important matrix data to ensure the allocated practices are green and have an “A” on the health scorecard.
8. Review Jira tickets created by RCM Client Advisors and global partners for timely resolution; analyze ticket trends to recommend fixes to reduce ticket traffic.
9. Present and review trends, issues and observations with RCM Client Advisors and join respective practice and vertical calls when appropriate.
10. 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.
11. Regularly review SOPs to ensure workflows are being followed as documented and any new opportunity is identified where workflows can be improved.
12. Work closely on new implementations to identify knowledge transfer challenges and audit the work before it is released.
13. Assist in monitoring of Service Legal Agreements (SLA) by our global partners as well as internal teams. 
14. Assist the  Lead in day-today operational tasks 
15. Act as a mentor for the new hires and bring them up the curve by reducing the learning curve
16. Work with the Training Lead on content creation and support them in training new hires
17. Perform additional projects and job duties as assigned.

The Role:

• 5+ years of hands-on experience in core Provider RCM 
• Overall experience includes a minimum of 2 years or more  as SME, Asst. Team Lead, Team Lead , QA, QA Lead, etc. 
• Prior experience in mentoring new joiners 
• Strong understanding of RCM Processes and best practices 
• Proven expertise in the AR follow up functions in multispeciality setup
• Knowledge of other related RCM functions is a must
• Advanced excel and presentation skills 
• Exceptional written, verbal and interpersonal communication skills required.
• Able to work during US night shift

ModMed 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