A Primer on the job roles available in the Industry
By Jacob Jesuroon, Senior Vice President and Head of People Function, Access Healthcare
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 an efficient workforce in delivering horizontal, non-industry-specific processes such as tech support, finance, accounting, etc. The information workers looked at their careers horizontally and referred to their job roles as a call center job or a data entry job.
Why IS INDUSTRY SPECIALIZATION important in BPO Careers?
While one can argue that transactional efficiency directly impacts business outcomes, it is not necessarily so. In the past two decades of the BPO industry, customer expectations have grown from SLAs to actual impact business outcomes. CFOs of Hospitals and physician practices are looking to achieve transformational business impact through service provider relationships. 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 Accountable Care Organizations, there is a greater focus on tying payments to quality metrics and the cost of care. We see service delivery operations increasingly relying on the cloud, analytics, robotic process automation, and artificial intelligence.
We see similar trends across industries, even more so in healthcare revenue cycle management. BPO service provides must start looking at specializing in different sectors or industry sub-segments and, therefore, one needs to look at specializing their careers in industry niches proactively. For those starting their careers in healthcare revenue cycle management or already working in the industry, we provide a view of different career streams and growth trajectories.
Revenue Cycle Services - Operations and Training Roles
Revenue Cycle Services Delivery Roles
Revenue Cycle Operations professionals can specialize in processes such as scheduling, registration, charge capture, remittance processing, accounts receivable management, and denials. While entry criteria include a graduation degree in many cases, candidates who bring in specialize in financial, clinical, and analytical acumen can succeed in these career streams. Only a few certifications are available for operations today, but we anticipate a more vital role of professional certification in the future. Operational leadership 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. Entry requirements are a life sciences degree and skills 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. Certification programs such as Certified Coding Associate (CCA®), Certified Coding Specialist (CCS®), and Certified Coding Specialist-Physician-based (CCS-P®) are available from 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 position requires a good understanding of the patient population, an understanding of their billing statements, and a strong customer service orientation.
Across the operations roles, one starts as an entry-level associate and can grow to become a subject-matter expert, a team leader, and then graduates to managerial positions. By design, each service delivery role has similar audit and quality management roles in a large-scale healthcare revenue cycle operation.
Training, transition, and project management
Training Roles. As one acquires and builds one’s knowledge of revenue cycle processes, one can also aspire to get into the training function. We recommend trainers have at least five years of experience in service delivery roles to be more effective. 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. The transition managers need to have good project management skills, effective communication skills, and the ability to understand different facets of revenue cycle operations.
Typically, transition and training roles require 4-5 years of operations experience. Successful trainers and transition managers possess an excellent grasp of revenue cycle content combined with effective communication and interpersonal skills. Project management, documentation, and communication skills can help you accelerate your growth in both training and transition management.
Sales, Client Services, and Solution Design Roles in Healthcare BPO
Sales roles. As with most sales roles, the ability to network with industry leaders assumes paramount importance. Our experience shows that successful sales leaders have a strong knowledge of revenue cycle processes, enabling them to engage with customers better through the deal life cycle. As constant in-person, connect with the customer is essential, organisations tend to locate most sales roles in the geographic location of 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 relationship-building skills with a strong communication of the account's success, issues, and challenges. The account manager takes a customer’s view into the service delivery organization and drives to 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, the ability to break down processes, estimate resource requirements, and can work with cross-functional teams to devise technology, process, and people solutions 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. Today, revenue cycle services delivery 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. These roles require an intrinsically strong grip on the process, with an ability to break down processes into components and rebuild new processes 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 key functional areas are:
Marketing and Communications. The marketing and communications domain offers 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. A high-quality facility and a pleasant, high-performance workplace are critical for a high-performance workforce. Procurement and finance enable the organization's senior leadership to have a critical grip on the firm's financial performance.
Human Resources. People are central to the success of a healthcare BPO organization. Several opportunities exist across the following career streams.
Recruitment and onboarding 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 candidates. Keeping the cost per hire low assumes paramount importance.
Engagement. Engagement plays a critical role in keeping employees motivated 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. The Compensation and Benefits team takes a holistic look at total pay including rewards and recognition processes to ensure parity of pay and create a culture of meritocracy.
In this article, we have strived to provide an overview of the business functions within an RCM service provider organization and hope that you will find these opportunities exciting.