Healthcare Operations Specialist

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation and workflow orchestration.

With over 30,000 employees globally and a robust presence in India, comprising over 17,000 employees across Delhi NCR, Hyderabad, Bangalore, and Chennai, we foster an inclusive culture where every team member feels valued and empowered. Our mission is to transform the healthcare industry by driving efficiency for healthcare systems, hospitals, and physician practices, continuously striving to make healthcare work better for everyone.

Designation : Operations Manager

Location : Hyderabad

Reports to (level of category) : Senior Operations Manager

Role Objective :

Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company.

Essential Duties and Responsibilities :

Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures.

Day-to-day operations

People Management (Work Allocation, On job support, Feedback & Team building)

Performance Management (Productivity, Quality, One-On-One sessions, KRA, PIP)

Reports (Internal and Client performance reports)

Work allocation strategy

CMS 1500 & UB04 AR experience is mandatory.

Span of control - 80 to 100

Thorough knowledge of all AR scenarios and Denials

Expertise in both Federal and Commercial payor mix

Excellent interpersonal skills

Should be capable to interact with US clients and manage escalations

Qualifications :

Graduate in any discipline from a recognized educational institute

Good analytical skills and proficiency with MS Word, Excel and PowerPoint

Good communication Skills (both written & verbal)

Skill Set :

Candidate should be good in Denial Management

Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials.

Ability to interact positively with team members, peer group and seniors.

Demonstrated ability to exceed performance targets.

Ability to effectively prioritize individual and team responsibilities.

Communicates well in front of groups, both large and small.