SENIOR MANAGER

Innoval Global Solutions; Maharashtra; On-site; INR 1,800,000 - 2,400,000; Full time

Job summary

Innoval Global Solutions in India seeks a Process Analyst/SME to provide deep domain expertise in the US Healthcare Revenue Cycle Management lifecycle, driving process optimization, AI/ML adoption, automation, and operational excellence across the full RCM cycle.

You will collaborate with business analysts, data scientists, RPA engineers, AI/ML teams, system analysts, and clients to implement AI-driven improvements, map workflows, ensure HIPAA and industry-standard compliance, and support

Qualifications

• Bachelor’s or Master’s degree in Healthcare Administration, Health IT, Business Analysis, or related field.
• 7–12+ years in US Healthcare RCM, with hands‑on experience across full-cycle processes.
• Strong knowledge of payer systems, EHR/EMR, PMS, clearinghouses, and EDI standards.
• Experience collaborating with technical teams to design automated, AI-enabled, and analytics-driven RCM workflows.
• Proven understanding of coding, billing, claims adjudication, and healthcare compliance.

Responsibilities

• End-to-End RCM Process Expertise: Analyze and optimize full RCM workflows across all modules.
• Map detailed process flows and system interactions for RCM operations.
• Maintain SOPs aligned with compliance, AI/automation, and system integrations.
• Validate payer databases, payer websites, and industry standards to ensure compliant workflows.
• Collaborate with AI/ML, data science, RPA, and client teams to implement improvements.
• Define KPIs and dashboards for operational and financial performance.

Skills

End-to-end RCM processes

Payer ecosystems

AI/ML integration

Workflow automation

Stakeholder management

Cross-functional collaboration

Education

Bachelor’s or Master’s degree in Healthcare Administration, Health IT, Business Analysis, or related field

Job description

Technical Expertise

EHR/EMR & PMS: Epic, Cerner, Allscripts, Meditech, AthenaHealth, NextGen

Product Development

Position Overview

We are seeking a Process Analyst / Subject Matter Expert (SME) to provide deep domain expertise in the full US Healthcare Revenue Cycle Management (RCM) lifecycle, driving process optimization, AI/ML adoption, automation, and operational excellence. The role spans the entire RCM cycle: Patient Registration → Eligibility & Benefits → Prior Authorization → Coding & Documentation → Charge Capture → Claims Submission → Payment Posting → Denial Management → Collections & Reporting.

The SME will focus on full RCM workflows, payer systems, EHR/EMR/PMS integrations, EDI transactions, coding standards, payer portals, and payer databases (e.g., NCCi, AAPC, AHIMA, AMA), ensuring compliant, scalable, and data-driven RCM operations and supporting analytics, AI/automation, and dashboard/reporting initiatives for US healthcare operations.

The role collaborates with business analysts, data scientists, RPA engineers, AI/ML teams, system/application analysts & developers, and clients to implement AI-driven process improvements.

Job Roles & Responsibilities

End-to-End RCM Process Expertise:

Analyze and optimize full RCM workflows, including Patient Registration, Eligibility Verification, Prior Authorization, Coding, Charge Capture, Claims Submission, Payment Posting, Denial Management, Collections, and Reporting.

Map detailed process flows, exceptions, and system interactions for RCM operations.

Maintain best-practice SOPs aligned with compliance, AI/automation, and system integrations.

Leverage knowledge of payer databases, payer websites, and industry standards (NCCi, AAPC, AHIMA, AMA) to validate claims and workflows.

Serve as domain expert across the full RCM cycle:

• Patient Registration & Scheduling
• Eligibility & Benefits Verification
• Prior Authorization
• Medical Coding (ICD-10, CPT, HCPCS)
• Claims Submission & Management
• Denials Management & Collections
• Revenue Reconciliation & Financial Reporting

Identify process gaps, inefficiencies, and automation opportunities within RCM workflows.

EHR/EMR/PMS & System Expertise

Work with EHR/EMR platforms, PMS systems, and integrated billing systems to align business processes with operational and AI workflows.

Collaborate with System/Application Analysts to ensure workflows translate into functional requirements.

Validate RPA, AI agents, and automation integrations within healthcare IT systems.

Payer & Market Intelligence

Maintain Expertise On Payer Systems, Portals, And Clearinghouses

• Commercial payers: UnitedHealthcare, Anthem, Aetna, Cigna, Humana, Blue Cross/Blue
• Government payers: Medicare, Medicaid
• Clearinghouses: Availity, Change Healthcare, Optum, RelayHealth, Trizetto

Conduct market research on payer rules, reimbursement policies, adjudication workflows, and claims lifecycle.

Maintain knowledge of professional coding & billing standards: AAPC, AHIMA, AMA CPT, ICD-10, HCPCS, NCCI edits.

AI/ML & Automation Enablement

Identify opportunities for AI/ML, GenAI, LLM-based agents, and Agentic AI in RCM workflows.

Partner with data scientists and RPA engineers to operationalize predictive models, agentic AI, and automated decision-making.

Support multi-agent orchestration, workflow automation, and analytics-driven process improvements.

Training, Mentorship & Knowledge Transfer

Serve as domain authority for cross-functional teams including AI, RPA, system analysts, and client stakeholders.

Conduct training sessions, workshops, and knowledge transfer for RCM systems, AI workflows, and compliance processes.

Develop process manuals, SOPs, and training materials integrating full RCM cycle knowledge with AI/automation best practices.

Technical Collaboration

Collaborate with Product, Engineering, Data, AI/ML, RPA, and DevOps teams to translate business and process requirements into technical solutions.

Support design and validation of end-to-end RCM tools, including workflow automation, AI/GenAI models, and multi-agent orchestration.

Work closely with data scientists, AI/ML engineers, cloud architects, RPA developers, and DevOps teams to ensure business requirements are translated into scalable, compliant solutions.

Support LLM Ops, MLOps, and Agentic AI deployment by defining input/output requirements, monitoring KPIs, and validating results.

Assist in integration of AI predictions and autonomous agent outputs into RCM and cloud workflows.

Analytics, Reporting & Insights

Define KPIs, dashboards, and reporting frameworks for operational, financial, and compliance performance.

Collaborate with data and analytics teams to ensure data accuracy, integrity, and actionable insights.

Conduct deep analysis of RCM projects, identifying trends, bottlenecks, and revenue optimization opportunities.

Compliance & Governance

Ensure adherence to HIPAA, SOC 2, GDPR, and internal healthcare compliance standards.

Maintain audit-ready documentation for AI/ML models, RPA workflows, and process changes.

Implement data governance and process validation frameworks for operational reliability.

Stakeholder Management

Serve as the liaison between technical teams, product owners, and business stakeholders.

Facilitate workshops, requirement reviews, and solution validation sessions.

Candidate Requirements

Bachelor’s or Master’s degree in Healthcare Administration, Health IT, Business Analysis, or related field.

7–12+ years in US Healthcare RCM, with hands‑on experience across full-cycle processes.

Strong knowledge of payer systems, EHR/EMR, PMS, clearinghouses, and EDI standards.

Experience collaborating with technical teams to design automated, AI-enabled, and analytics-driven RCM workflows.

Proven understanding of coding, billing, claims adjudication, and healthcare compliance.

Technical Expertise

EHR/EMR & PMS: Epic, Cerner, Allscripts, Meditech, AthenaHealth, NextGen

Payer Portals & Clearinghouses: Availity, Change Healthcare, Optum, RelayHealth, Trizetto

EDI Standards: X12 837 (claims), 835 (remittance), 270/271 (eligibility), 276/277 (claim status), 278 (prior authorization)

Coding & Compliance: ICD-10, CPT, HCPCS, NCCI edits, AAPC, AHIMA, AMA CPT

Analytics & Reporting: SQL, Snowflake, Redshift, Tableau, Power BI

AI & Automation Collaboration: Guide LLM Ops, Agentic AI, GenAI, and RPA workflow integration

Skillset

Deep understanding of end-to-end US RCM processes and payer ecosystems.

Ability to analyze, document, and optimize complex workflows for automation and AI integration.

Expertise in EDI transactions, payer rules, and coding compliance.

Strong analytical, problem-solving, and reporting skills.

Excellent communication, stakeholder management, and knowledge transfer skills.

Experience in cross‑functional collaboration with technical and operational teams.

Ability to translate complex technical workflows into actionable business insights.

Understanding in AI/ML, RPA, Agentic AI, and healthcare operations.

Knowledge of compliance, governance, and audit standards.

Ability to drive cross‑functional collaboration and solution adoption.

Strategic Impact

Ensure comprehensive RCM process coverage across all modules and systems.

Enable AI/automation adoption by providing domain and workflow expertise.

Reduce process inefficiencies and claim denials, improving revenue and compliance.

Bridge business operations and technical development for scalable RCM solutions.