8 Provider Management Jobs

Job Title: Senior CSA Job Category: Associate Function/Department: Operations Role Description: Roles & Responsibilities Processing and data entry for routine types of physician and contract linkage transactions such as: Load new physician demographics and contract linkage using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Perform physician demographics and contract linkage data using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Responsible for ensuring all data elements necessary to complete the request are provided and responds to the submitter with a detailed outline if additional information is needed Use desk-top macros whenever possible to ensure data loading accuracy and efficiency Send large requests capable of being automated as defined by management to the AST Provide excellent customer service to customers (physician, health plans, affiliates, delegates, insured, and all associated business partners) by: Quickly and accurately identifying and assessing customer needs and taking appropriate action steps to satisfy those needs Solve problems systematically using sound business judgment and following through on commitments using an automated approach whenever possible Respond to customers in a polite and professional manner Complete assigned work within established TAT and Quality metrics while remaining within downtime parameters to ensure customer satisfaction Key Results Production, Quality Shift and Schedule adherence Process Knowledge Role Holder Profile A. Preferred educational qualifications: Graduation (Any discipline - 3 years) without arrears. B. Preferred work experience: Minimum 6 months to 1 year of experience in Provided Data Management C. Skills and Competencies Mandatory knowledge in health care industry and PDM Working knowledge of systems platforms preferred PC skills (Power Point, Word, Excel, Access, Lotus Notes, Intranet) preferred Strong customer service orientation required i. Functional / Technical: ii. Behavioral: Shift Adherence Floor Decorum Interpersonal skills Team Player

Manager-Segment Incharge The role is responsible for all tasks related to Processing and Settlement of claims, Monitoring TPA performance for the assigned business. The role includes managing the assigned specialized business handling of any one or more of the following activities: Settlement of Claims, Monitoring TPA performance based on defined KPI, System, Development, UAT, Portfolio Analysis, MIS/Compliance. If this is you, we are looking for you! Key Responsibilities Managing end-to-end claims. Requisitioning detailed information on all reported and settled Claims and monitoring performance of TPAs, evaluating performance of all TPA based on parameters of SLA with Regular Review of defined KPIs. Monitoring and performance evaluation of TPA including timely review of TAT & quality for various process followed in TPAs, daily TAT monitoring, escalation & expectations management for specialized business handling of retail portfolio. Maintaining and updating TPA records on daily basis which help us to know the performance of retail policies and portfolio. Conducting QC of reports and data of TPA shared with us on regular intervals to analysis the data on all benefits as per retail policies. Supporting Actions IT Systems Development System development for uploading and extracting TPA claims and generating reports from the same. Cost containment without losing on customer experience, actionable of feedbacks on claims experience. Educational Qualification: - Preferably MBBS, BHMS, BAMS Doctor Minimum 7-9 years in handling similar role Experience in handling provider management (Hospitals and other vendors) is mandatary. Its a urgent opening please share your resume at aparna@aceconsultants.in

Job Title: Business Analyst (Preferably from Healthcare IT domain) Location: Chennai - DLF Job Type: Full Time Experience Level: [Mid-Level / Senior-Level] Department: IT / Healthcare Solutions Job Summary: We are seeking a highly motivated and detail-oriented Business Analyst with strong experience in the Healthcare IT domain . The ideal candidate will bridge the gap between business needs and technology solutions, working closely with stakeholders to define requirements, streamline processes, and implement solutions that support our healthcare initiatives. Required Skills & Qualifications: Bachelors degree in Computer Science, Information Technology, Healthcare Administration, or related field. 510 years of experience as a Business Analyst, preferably in the Healthcare IT domain. Strong understanding of healthcare systems including EHRs/EMRs (e.g., Epic, Cerner), claims systems, and patient management platforms. Experience with Agile, Scrum, or other SDLC methodologies. Excellent communication, documentation, and stakeholder management skills. Proficient in tools such as JIRA, Confluence, MS Visio, Balsamiq, or similar. If interested kindly share your updated CV to priyad@kyyba.com along with the following details, No of years of Experience - Experience in Healthcare IT - Notice Period - How soon can join - Current CTC - Expected CTC -

Greetings!!! Openings at Sagility for Process Trainer(US Healthcare) Minimum of 4 years of experience as a Process Trainer in an International BPO. Excellent written and verbal communication skills, with strong interpersonal abilities. Proven experience as a Trainer in an International BPO environment. Strong presentation and Excel skills. Sound knowledge of basic training methodologies. Ability to work in US rotational shifts. Immediate joiners are mostly preferred. Interested candidates can share your resume to anitha.c@sagilityhealth.com

Job Description: Solicit, review and analyze business requirements Write business and technical requirements Communicate and validate requirements with stakeholders Validate solution meets business needs Work with application users to develop test scripts and facilitate testing to validate application functionality and configuration Participate in organizational projects and/or manage small/medium projects related to assigned applications Translates customer needs into quality system solutions and ensures effective operational outcomes Focus on business value proposition*Apply understanding of 'As Is' and 'To Be' processes to develop solution Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). Role Focus Areas: Core Expertise Required: Provider Management Utilization Management Care Management Domain Knowledge: Value-Based Care Clinical & Care Management Familiarity with Medical Terminology Experience with EMR (Electronic Medical Records) and Claims Processing Technical/Clinical Understanding: Admission & Discharge Processes CPT Codes, Procedure Codes, Diagnosis Codes Job Qualification: Undergraduate degree or equivalent experience. Minimum 5 Years experience in Business Analysis in healthcare including providing overall support, maintenance, configuration, troubleshooting, system upgrades, and more for Healthcare Applications. Good experience on EMR / RCM systems Demonstrated success in running EMR / RCM / UM, CM and DM systems support in requirements, UAT, deployment supports Experience working with stakeholders, gathering requirements, and taking action based on their business needs Proven ability to work independently without direct supervision Proven ability to effectively manage time and competing priorities Proven ability to work with cross-functional teams Core AI Understanding AI/ML Fundamentals: Understanding of supervised, unsupervised, and reinforcement learning. Model Lifecycle Awareness: Familiarity with model training, evaluation, deployment, and monitoring. Data Literacy: Ability to interpret data, understand data quality issues, and collaborate with data scientists. AI Product Strategy AI Use Case Identification: Ability to identify and validate AI opportunities aligned with business goals. Feasibility Assessment: Understanding of whats technically possible with current AI capabilities. AI/ML Roadmapping: Planning features and releases that depend on model development cycles. Collaboration with Technical Teams Cross-functional Communication: Ability to translate business needs into technical requirements and vice versa. Experimentation & A/B Testing: Understanding of how to run and interpret experiments involving AI models. MLOps Awareness: Familiarity with CI/CD for ML, model versioning, and monitoring tools. AI Tools & Platforms Prompt Engineering (for LLMs): Crafting effective prompts for tools like ChatGPT, Copilot, or Claude. Responsible AI & Ethics Bias & Fairness: Understanding of how bias can enter models and how to mitigate it. Explainability: Familiarity with tools like SHAP, LIME, or model cards. Regulatory Awareness: Knowledge of AI-related compliance (e.g., HIPPA, AI Act). AI-Enhanced Product Management AI in SDLC: Using AI tools for user story generation, backlog grooming, and documentation. AI for User Insights: Leveraging NLP for sentiment analysis, user feedback clustering, etc. AI-Driven Personalization: Understanding recommendation systems, dynamic content delivery, etc.

Key Responsibilities: 1. Hospital Visit Management: Conduct regular visits to hospital partners to review and address pricing structures, contract terms, and service quality. Analyze and assess hospital billing and pricing strategies to ensure alignment with organizational objectives. 2. Claims Negotiation: Lead negotiations with hospital partners regarding claims and reimbursement issues to ensure favorable outcomes for the organization. Work closely with the internal claims team to resolve discrepancies and expedite claim resolutions. 4. Pending Issues and Concerns: Identify, track, and resolve pending issues and concerns related to hospital partnerships, including billing disputes, service quality, and contractual obligations. Act as a liaison between the hospital and internal teams to address and mitigate concerns promptly. 5. Coordination with Internal Stakeholders: Collaborate with internal departments to ensure alignment on hospital-related activities and strategies. Facilitate effective communication and coordination between internal teams to address issues and implement solutions. 6. Documentation and Reporting: Prepare and maintain comprehensive documentation of hospital visits, pricing agreements, claims negotiations, and issue resolutions. Document and update sales meetings, including key takeaways, action items, and progress reports. 7. Sales Meeting Coordination: Organize and lead sales meetings to discuss hospital partnerships. Provide regular updates and reports to sales teams and management on hospital-related activities and performance.

Were Hiring: Senior Mobile Developer (React Native) Are you passionate about building seamless, high-quality mobile experiences on both Android and iOS platforms? Join our dynamic team and help shape the future of our mobile applications! What You'll Bring: Bachelors or Masters degree in Computer Science, Engineering, or a related field. 6+ years of hands-on mobile development experience. Proven track record of building and deploying apps on Android and iOS. Expertise in React Native, QuickType, React Context API/Redux, UI Components, and Axios. Experience with state management frameworks like Provider, Riverpod, or BLoC. Strong knowledge of Android SDK, iOS SDK, and platform-specific development nuances. Skilled in integrating mobile apps with REST APIs, Firebase, and cloud services. Proficient with Git and version control workflows. Familiarity with app store submission processes, guidelines, and release management. Excellent analytical and problem-solving skills. A collaborative mindset and ability to thrive in a team environment. Why Join Us? Work on exciting projects that impact millions of users. Collaborative, innovative, and supportive work culture. Opportunities for professional growth and skill development. Ready to take your mobile development career to the next level? Apply now or share with someone who would be a perfect fit!

Greetings!!! Openings at Sagility for Process Trainer-Enrollment(US Healthcare) Minimum of 4 years of experience as a Process Trainer in an International BPO. Excellent written and verbal communication skills, with strong interpersonal abilities. Proven experience as a Trainer in an International BPO environment. Strong presentation and Excel skills. Sound knowledge of basic training methodologies. Ability to work in US rotational shifts. Immediate joiners are mostly preferred. Interested candidates can share your resume to anitha.c@sagilityhealth.com