Allscripts jobs in Pune, Maharashtra

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 Shield
  • 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.

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