Senior Program Manager (Healthcare Reimbursement/Contract Modelling)

About the role: 

Needs to work closely and communicate effectively with internal and external stakeholders in an ever-changing, rapid growth environment with tight deadlines. This role involves designing   and analyzing the healthcare reimbursement model. Be able take up new initiatives, maintain synchrony in the team. Collaborate with external & internal stakeholders, work effectively in a growing team, be a strong team player. Be able to create and define SOPs, TATs for ongoing and upcoming projects.

What you will do: 

• To design, analyze and maintain healthcare reimbursement models to ensure the revenue estimation is in-line with the contracts. 
• To perform various analytical reviews and deep-dives (root cause analysis) on client-specific healthcare reimbursement methodology to ensure accuracy of revenue projections and actual collections.
• To report/highlight the exceptions in reimbursement method by building contract models for Hospital charges
• To effectively communicate the findings/ observations with recommended action to US team/clients. 
• Maintain MIS related to analysis, Accuracy and coverage report for maintenance databases
• Handling client calls and communicating effectively for task deliverables and site maintenance

What will you need:

• Graduate degree Preferably in Statistics\ Mathematics\ Economics\ Commerce\Finance from a reputed educational institute
• Good analytical and algorithm building skills, having experience to build contract models for hospital charges to calculate expected reimbursement
• Skills to read, understand and interpret reimbursement contracts between hospitals and insurance providers.
• Experience/knowledge of various US healthcare reimbursement methods like MS DRG weightage, Multipliers, % of charges, outliers, Grouper fee schedule etc.
• Good Communication Skills (both written & verbal)
• Preferable - 1-3 years of experience in US healthcare
• Having good knowledge about RCM cycle and denial management

Interested candidates can share their resume at krawat9@r1rcm.com