Clinical Services Manager

Job Title: Clinical Services Manager

Location: McKinley, Taguig

Work set-up: Onsite

Company Overview:

AGS Health is more than a revenue cycle management company - we're a strategic partner for growth. With expert services complemented by AI-enabled technologies and high-touch support, AGS Health is the premier revenue cycle partner for leading health systems, physician groups, and academic medical centers in the U.S. With expert insight into modern revenue cycle practices, the company pairs cutting-edge technology with college-educated, trained RCM experts to help clients optimize workflow, maintain compliance, prevent revenue leakage, and achieve a high-performance revenue cycle. AGS health employs more than 14,000 team members globally and partners with more than 150 clients across a variety of care settings, specialties, and billing systems.

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SCOPE OF WORK:

· The position will report directly to the Vice President of Coding and Clinical Service Line. This is an Individual Contributor role focusing on independent work and expertise within a specific area, rather than managing a team or having managerial responsibilities. The individual will be responsible for delivering improved performance/results through key stakeholder engagement and problem-solving skills.

· This role will support service line leadership collaboration with AGS teams including Operations, Sales, Customer Success, Marketing, Talent Development, and Quality Audit teams. Examples include:

o Drive quality improvement initiatives within the clinical service line

o Refine AGS's quality audit framework as industry trends and regulatory requirements evolve

o Create case studies from clinical projects utilizing "real time" key outcomes and data

o Participate in general go-to-market initiatives as needed

· The individual will monitor clinical pipeline to build thoughtful presentations for leadership meetings, strategic initiatives and other efforts. Navigate sales platform, quantify relevant pipeline, and assist with prioritizing pursuits.

· The individual will work adjacent to the Sales / Customer Success teams to build compelling value propositions and customized solutions during the sales cycle. May require researching competition and updates on global market trends within the clinical RCM domain.

· This position will also support the Director – Clinical Education with development and refinement of education and training content for AGS resources within the clinical service lines (Clinical Authorizations, Clinical Denials & Appeals, Physician Advisory Services, Clinical Documentation Integrity, and Utilization Review) across global locations

· This role will also support the expansion into new clinical administrative service lines such as care management and coordination, pharmacovigilance, etc.

JOBS-TO-BE-DONE (JTBDs):

1. Serve as clinical SME in support of the following:

a. Support VP of Coding and Clinical Service Line – Drive operational excellence and collaboratively assist the VP with tasks to execute the organization's strategy for the relevant service lines.

b. Go to Market Support – Be able to communicate effectively to internally and externally with clinical domain acumen. Support AGS's thought leadership by researching and creating content for market-focused communications (e.g., white papers, collaterals, case studies, clinical sections of the website, webinars). Help ensure the content remains current with industry-leading solutions and delivery locations.

c. Clinical analytics – assist with the identification and collection of key performance indicators for the clinical service lines; utilize current project data to generate insights related to production, quality, and outcomes for both external and internal uses.

d. Education and Training – Support the Director Clinical Education to develop and refresh clinical services training content. Assist with the collaboration among AGS internal teams, including Talent Development and Operations, for a comprehensive approach. Knowledge of industry trends and regulatory compliance matters will be important.

1. Support the refinement, further development, and implementation of the company's Clinical Solutions strategy in line with AGS's long-term (5+ year) strategic plan

2. Support other clinical service line initiatives as requested.

KEY SELECTION CRITERIA:

Candidate qualifications:

1. Minimum of 5+ years combined experience in direct patient care and/or a clinical administrator role such as: utilization management, clinical authorization, clinical denials or clinical documentation integrity with a professional history in reputable companies.

a. Registered Nurse (RN) or other clinical patient care designation

b. BS/BA is required and a graduate degree in health, medicine, or nursing is preferred

c. Adjacent experience with US revenue cycle is a plus

1. Knowledge of the US healthcare industry, including a broad understanding of both the payor and provider ecosystems and how they interrelate. Grasp of clinical RCM vendors / services / trends / disruptions / service differentiators.

2. Strong understanding and experience working with revenue cycle-related technology in the clinical revenue cycle, including computer-assisted CDI, auditing, utilization management review, clinical appeal automation, etc.

3. Global Experience – preferred experience of 2+ years of working in/with global RCM business process outsourcing delivery models

4. Ability to constantly learn and synthesize – active listener with intellectual curiosity. Keep up to date on industry trends to shape the Solutions framework and intellectual property for the service line.

5. Product knowledge – broad understanding of AGS products/services and how they interplay, coupled with strong knowledge of technology solutions and platforms

6. Demonstrates initiative and strives for excellence for him/herself and his/her team.

Compliance:

Awareness and adherence to all applicable organization-wide policies and procedures, including but not limited to Information security, HIPAA, and HR policies

· Should adhere to applicable Do's & Don'ts of implemented Information Security Management System, including HIPAA, HITRUST, and NIST regulations

· Adherence to the rules and regulations as outlined by the management

KEY SUCCESS FACTORS:

· Fluent in English. Professional and polished written and verbal communication skills

· Analytical thinking

· Desire to operate in a fast-paced environment and work with a cross-functional team spread across different geographical locations

· BPO industry knowledge, including an understanding of enabling functions (quality, training, hiring, technology, pricing, etc.) and operating environment

· Ability to work seamlessly with virtual teams