A Primer on the job roles available in the Industry
Over the last two decades, Business Process Outsourcing has become a core theme in enterprise strategy, enabling the outsourcing organization to unlock the benefits of cost savings, while getting predictable SLA based business process delivery. Over these years, service providers have built a workforce that was efficient in delivering horizontal processes, and the information workers really looked at their careers horizontally and referred to their job roles as a call centre job or a data entry job.
Why Industry Specialization is important in BPO Careers?
While it can be argued that transactional efficiency has a direct impact on business outcomes, it is not necessarily so. In the past two decades, customer expectations have grown from SLAs to true business outcomes. As a one looks at the healthcare revenue cycle management industry, the way customers look at their business has changed significantly. On one side healthcare providers have consolidated, becoming more focused on specialties, on the other side, the lines between physician practices and hospitals have started blurring. With the advent of the Accountable Care Organizations, there is greater focus on tying payments to quality metrics and the cost of care. Further, we are seeing service delivery operations changing with increasing role for cloud, analytics, robotic process automation, and artificial intelligence.
We are seeing similar trends across industries, and even more so in healthcare revenue cycle management. BPO service provides must start looking at specializing in different industries or industry sub segments and, therefore, one needs to proactively look at specializing their careers in industry niches. For those who are starting out their careers in healthcare revenue cycle management, or are already working in the industry, we provide a view of different career streams.
Revenue Cycle Services - Operations and Training Roles
Revenue Cycle Services Delivery Roles
- Revenue Cycle Operations professionals Specialize in processes such as scheduling, registration, charge capture, remittance processing, accounts receivable management and denials. While in many cases, entry criteria include a graduation degree, it is recommended that one has a financial, clinical and analytical acumen in these career streams. Few certifications are available for operations roles today, but we anticipate the stronger role of certifications in the years to come. Similar roles are available in quality and audit functions as well.
Medical Coding Services roles
- Medical Coding is perhaps one of the most talked about roles. Ticket to entry requires a life sciences degree, and the ability to comprehend medical terms. Growing your career in Medical Coding requires you to acquire certifications, often facilitated by your employers. Certifications such as Certified Professional Coder (CPC®), Certified Outpatient Coding (COC™), and Certified Inpatient Coder (CIC™), are available from AAPC. Certifications such as Certified Coding Associate (CCA®), Certified Coding Specialist (CCS®), and Certified Coding Specialist-Physician-based (CCS-P®) are available for AHIMA.
Accounts receivable and customer service roles
- Customer Service roles focus on providing support to patients and providers through the multi-channel contact center. The role requires a good understanding of the patient population, understanding of their billing statements, and strong customer service orientation.
Across the operations roles, one starts as an entry-level associate and moves on to become a subject matter expert - Team leader, and then graduate to managerial roles. Similarly, each of the service delivery roles has commensurate service quality roles as well.
Training, transition, and project management
- Training Roles. As one acquires and builds one’s knowledge of revenue cycle processes, training is another area one can look at getting into. We recommend trainers to have at least five years of experience in service delivery roles to be more effective. Having said that, trainers need to have a passion for training and strong communication and articulation skills.
- Transition and Project Management. Experienced team leaders and managers can look at taking on process transition roles. Process transitions are intensive activities involving managers and leaders from the customer organization. Not only do the transition managers need to have good project management skills, but also effective communication skills along with the ability to understand different facets of revenue cycle operations.
Typically, transition and training roles require 4-5 years of operations experience. A good grasp on revenue cycle content combined with effective communication and interpersonal skills are required for both the roles. Ability to manage projects and change is key in transition roles whereas training roles require stronger documentation skills.
Sales, Client Services, and Solution Design Roles in Healthcare BPO
- Sales roles. As with most sales roles, the ability to network assumes paramount importance. Our experience shows that successful sales leaders have a strong knowledge of revenue cycle processes which enables them to engage with customers better through the deal life cycle. The nature of these roles requires the sales leaders to be located closer to the customers.
- Client Services. Account management and client services roles require day to day interaction with customers on service delivery. A good account manager combines the relationship building skills with a strong communication of the success, issues and challenges in the account. The account manager takes a customer’s view into the service delivery organization and drives focus on results that matter the most to the customer
- Solution Design. Solution Design is a new and emerging career option for people who have good analytical skills, ability to break down processes, estimate resource requirements and can work with cross functional teams to devise technology, process and people solution to deliver and transform revenue cycle processes effectively
IT, Product & Project Management roles in a Healthcare BPO
Healthcare IT services and process automation
- IT Services. Revenue cycle services delivery, today, requires a significant focus on technology and automation and hence there is an increased role for systems integration.
- Process Transformation and Robotic Process Automation
- Process Transformation. Mature Revenue Cycle delivery organizations have good process transformation practices such as Six Sigma and Lean. The ability to shift focus from SLAs to business outcomes for customers
- Robotic Process Automation. Some, not all, of the leading Revenue cycle service providers have a good robotic process automation practice as well. These roles require an intrinsically strong grip on the process, with an ability to break down processes into components and rebuild new process with an overlay of technology to reduce overall effort. Technologies such as Artificial Intelligence/ Machine Learning, RPA, and cloud are some of the technologies that come together to provide a holistic robotic process automation solution
Corporate Functions in a Healthcare BPO Organization
Corporate functions play a vital role in a business process outsourcing organization. Some of the key functional areas are:
- Marketing and Communications. The marketing and communications domain offer interesting career opportunities. The ability to perform multivariate market analysis to segment, target and position the company’s products and services in the market space, communicate the value proposition, and enhance the company’s network are the skills required to succeed in the marketing role.
- Finance, facilities, & procurement. As with any other organization, finance, facilities, and procurement are critical functions within revenue cycle BPOs. High-quality facility and a congenial, high-performance workplace are critical for a high-performance workforce. Procurement and finance enable the senior leadership of the organization to have a critical grip on the financial view of the firm.
- Human Resources. People are central to the success of a healthcare BPO organization. Several opportunities exist across the following career streams.
- Recruitment and on-boarding of resources. Multi-channel, large-scale recruitment programs require recruitment leaders to embrace and implement new age technologies leveraging digital, and traditional mediums to source potential hire. Keeping the cost per hire low assumes paramount importance.
- Engagement. Engagement plays a critical role in keeping employee motivation and handling grievances.
- Compensation and Benefits Administration. Rated as the most important team in the HR department, the objective of this team is to ensure effective design, management, and distribution of remuneration packages. Compensation and Benefits team takes a holistic look at total pay including rewards and recognition processes to ensure parity of pay and creation of a culture of meritocracy.
In this article, we have strived to provide an overview of the business functions within a revenue cycle management service provider organization.
ABOUT ACCESS HEALTHCARE
Access Healthcare provides business process outsourcing, applications services, and robotic process automation tools to healthcare providers, payers, and related service providers. We operate from 12 delivery centers across US, India and the Philippines. Our 8,000+ staff is committed to bringing revenue cycle excellence to our customers by leveraging technology, emerging best practices, and global delivery. Based in Dallas, we support over 150,000 physicians, serve 80+ specialties, process over $ 50 billion of A/R annually, and ascribe medical codes to over 10 million charts annually. To learn how Access Healthcare can help your organization boost its financial performance, visit accesshealthcare.org.
For career opportunities with Access Healthcare, visit https://www.accesshealthcare.org/career/