Business process outsourcing has emerged as a central corporate strategy topic over the past 20 years, allowing the outsourcing company to realize cost savings and obtain consistent SLA-based business process delivery.  Service providers have developed a skilled workforce over the years to handle horizontal, non-industry-specific tasks like tech support, finance, accounting, etc. The information workers described their jobs as data entry or call center jobs and approached their careers in a horizontal manner.

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Although it is debatable, transactional efficiency may not always have a direct impact on business outcomes. Customer expectations in the BPO sector have evolved over the last 20 years, moving from SLAs to actual business outcomes. Hospital and medical practice CFOs want to build connections with service providers that will have a transformative business impact. The boundaries between medical practices and hospitals have begun to blur. On the one hand, healthcare providers have consolidated and are focusing more on specializations. 

The introduction of Accountable Care Organizations has led to an increased emphasis on linking payments to quality measurements and overall healthcare costs. Robotic process automation, artificial intelligence, cloud computing, and analytics are becoming more and more important to service delivery operations.

Across industries, we observe similar tendencies; in healthcare revenue cycle management, this is even more evident. One needs to proactively consider specializing in industry niches in order for BPO service providers to start considering specializing in various industries or industry sub-segments. We offer a perspective of various career streams and growth trajectories for people just starting out in the field of healthcare revenue cycle management or for those who are already employed in it.

 Revenue Cycle Services Delivery Roles : Professionals in revenue cycle operations can focus on handling accounts receivable administration, scheduling, registration, charge capture, remittance processing, and denials. Although a graduation degree is frequently required for admission, candidates with a focus on clinical, financial, or analytical skills might excel in these career streams. Currently, there aren’t many credentials accessible for operations, but we believe that professional certification will play a bigger part in the future. There are operational leadership positions available in audit and quality departments as well.

Probably one of the most talked-about jobs is medical coding. A life sciences degree and the ability to understand medical terminology are prerequisites for admission. In order to advance in the medical coding field, you must obtain certifications, which are frequently provided by your employers. AAPC offers a number of certifications, including Certified Professional Coder (CPC®), Certified Outpatient Coding (COCTM), and Certified Inpatient Coder (CICTM). The American Healthcare Association (AHIMA) offers certification programs in Certified Coding Associate (CCA®), Certified Coding Specialist (CCS®), and Certified Coding Specialist-Physician-based (CCS-P®).

Account Recievable and Customer Service Role : The primary responsibility of customer service positions is to assist patients and providers via the multi-channel contact center. Strong customer service skills, familiarity with patient billing statements, and knowledge of the patient population are prerequisites for this role.

In the operations domain, an individual may begin as an associate at the entry level and progress to become a team leader, subject matter expert, or manager. Every service delivery function in a large-scale healthcare revenue cycle organization is designed to be similar to audit and quality management roles.

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Training Roles: One can aim to enter the training role as they gain and expand their understanding of revenue cycle processes. For maximum effectiveness, we advise trainees to have at least five years of experience in service delivery jobs. In addition to having excellent communication and articulation abilities, trainers must be passionate about training.

Transition and Project Management : Managers and team leaders with experience might consider assuming process transformation responsibilities. Managers and executives from the client company are heavily involved in process transformations. The transition managers must be proficient in project management, have strong communication skills, and comprehend the various aspects of revenue cycle operations.

Four to five years of operations experience are usually required for transition and training roles. Effective communication and interpersonal skills are paired with a thorough understanding of the revenue cycle content by successful trainers and transition managers. Your progress in training and transition management can be accelerated with the aid of project management, documentation, and communication skills.

Sales Roles : Similar to most sales positions, networking with influential people in the field is crucial. Our research demonstrates that proficient sales executives possess a solid understanding of revenue cycle procedures, which empowers them to interact with clients more effectively throughout the transaction life cycle. Since maintaining a face-to-face connection with consumers is crucial, most sales positions are typically located close to the customers’ locations.

Client Services : Daily customer engagement is necessary for jobs in account management and client services in order to provide services. A competent account manager blends interpersonal abilities with effective communication of the account’s problems, successes, and difficulties. The account manager drives to concentrate on outcomes that are most important to the customer by adopting a customer’s perspective of the service delivery company.

Solution Design : A new and developing career path called “solution design” is for individuals with strong analytical abilities, the capacity to deconstruct processes, the ability to project resource needs, and the capacity to collaborate with cross-functional teams to develop technology, process, and human resource solutions that will successfully deliver and transform revenue cycle processes.

IT Services:  Delivering revenue cycle services now necessitates a strong emphasis on automation and technology, which means that systems integration plays a bigger part.

Process Transformation : Well-established revenue cycle delivery companies use Lean and Six Sigma as effective process transformation techniques. The capacity to change the emphasis from SLAs to customer business results

Robotic Process Automation : A few of the top revenue cycle service providers, but not all of them, have effective robotic process automation techniques. These positions demand an innately firm grasp of the process, as well as the capacity to disassemble existing processes into their component parts and reconstruct new ones using technology to save labor costs. Robotic process automation (RPA) is facilitated by a combination of technologies, including cloud computing, RPA, and artificial intelligence/machine learning.

In a corporation that outsources business processes, corporate functions are essential. A few crucial functional domains are:

Communications and Marketing:  There are intriguing employment prospects in the marketing and communications industry. To succeed in the marketing function, one must be able to conduct multivariate market analysis in order to segment, target, and position the company’s goods and services in the market, as well as convey the value proposition and strengthen the company’s network.

Finance, facilities, & procurement: Revenue cycle BPOs depend on finance, facilities, and procurement as much as any other company. A high-performance workforce requires both a top-notch workspace and an enjoyable environment. The organization’s top leadership can exert a significant influence over the financial performance of the company thanks to procurement and finance.

Human Resources. : A healthcare BPO organization’s performance is largely dependent on its workforce. There are several opportunities in each of the following career paths.

Recruitment and onboarding of resources : Recruitment leaders must embrace and utilize new age technology in multi-channel, large-scale recruitment initiatives that leverage internet and conventional media to source potential candidates. It becomes crucial to keep the cost per rental low.

Engagement : Engagement plays a critical role in keeping employees motivated and handling grievances.

Compensation and Benefits Administration :  The goal of this team, which is regarded as the most significant in the HR division, is to guarantee efficient compensation package creation, administration, and distribution. In order to guarantee pay equity and foster a meritocratic culture, the Compensation and Benefits team takes a comprehensive approach to total compensation, including awards and recognition programs.

We hope you find these potential interesting as we have attempted to present an outline of the business functions within an RCM service provider firm in this article.

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