Director - Capability (Healthcare)

Key Responsibilities:Business Analysis & Requirements Gathering• Engage with RCM stakeholders (operations, compliance, technology) to gather and document detailed business requirements across intake, coding, billing, claims, A/R, and denials.• Define user stories, business rules, data flows, and system behavior aligned with operational outcomes.• Work closely with product managers to prioritize features based on business value and technical feasibility.Subject Matter Expertise (SME)• Provide domain expertise in U.S. healthcare revenue cycle processes and technologies.• Offer field-level insights from front-end intake through back-end collections and appeals.• Advise on industry best practices, compliance considerations, and emerging trends in automation and AI adoption in RCM.Techno-Functional Collaboration• Act as a liaison between business users and development teams to ensure solution design aligns with functional needs.• Partner with architects and engineers on data modeling, workflow engines, and AI/ML model integration.• Participate in user acceptance testing (UAT), validating system outputs against business expectations.Platform Innovation• Contribute to platform design and modularization of features such as (but not limited to):o Claims Automation (e.g., OCR, NLP, intelligent form capture)o Autonomous Coding (ICD/CPT code prediction using AI/ML)o Process Optimization (clearinghouse logic, eligibility validation)o Denials Prevention & Prediction (ML-based denial scoring, root cause analytics)• Identify opportunities for AI/automation to enhance accuracy, reduce TAT, and minimize human intervention.Documentation & Change Management• Develop clear documentation including BRDs, FRDs, process maps, and data dictionaries.• Support training, change management, and knowledge transfer to internal teams and client stakeholders.