Director - Capability (Healthcare)
Director - Capability (Healthcare)
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Job Description
Key Responsibilities:Business Analysis & Requirements Gathering Engage with RCM stakeholders (operations compliance technology) to gather and document detailed business requirements across intake coding billing claims A/R and denials. Define user stories business rules data flows and system behavior aligned with operational outcomes. Work closely with product managers to prioritize features based on business value and technical Matter Expertise (SME) Provide domain expertise in U.S. healthcare revenue cycle processes and technologies. Offer field-level insights from front-end intake through back-end collections and appeals. Advise on industry best practices compliance considerations and emerging trends in automation and AI adoption in -Functional Collaboration Act as a liaison between business users and development teams to ensure solution design aligns with functional needs. Partner with architects and engineers on data modeling workflow engines and AI/ML model integration. Participate in user acceptance testing (UAT) validating system outputs against business Innovation Contribute to platform design and modularization of features such as (but not limited to):o Claims Automation (e.g. OCR NLP intelligent form capture)o Autonomous Coding (ICD/CPT code prediction using AI/ML)o Process Optimization (clearinghouse logic eligibility validation)o Denials Prevention & Prediction (ML-based denial scoring root cause analytics) Identify opportunities for AI/automation to enhance accuracy reduce TAT and minimize human & Change Management Develop clear documentation including BRDs FRDs process maps and data dictionaries. Support training change management and knowledge transfer to internal teams and client stakeholders.
Qualifications :
Qualifications: Bachelors degree in Healthcare Administration Information Systems Computer Science or related field. 10 years of experience in RCM operations product development or business analysis preferably in a healthcare technology or BPO setting. Deep understanding of end-to-end RCM workflows and pain points. Experience working with or designing solutions involving automation RPA AI/ML and data analytics. Familiarity with RCM platforms EHRs (e.g. Epic Cerner Athena) and clearinghouse Skills: Experience with product development lifecycles (Agile Scrum). Experience in working with wide range of practice management systems used by providers in the US Data sourcing and integration experience with leading EHR/EMR clearing houses and payer claims systems Proficiency in tools such as JIRA Confluence Lucidchart/Visio SQL. Exposure to technologies like OCR NLP RPA (UiPath Automation Anywhere) and machine learning models. Certifications in Business Analysis (CBAP/CCBA) Healthcare IT (e.g. CPHIMS) or Lean/Six Sigma.
Remote Work :
No
Employment Type :
Full-time
Employment Type
Full-time
