Careers At Sagility

Ideation Lead-Outpatient

Job Code : GEN/1185

Job Description

About Sagility 

Sagility is a tech-enabled BPM services provider, a thought partner providing a broad spectrum of transformational services, to enable our clients provide efficient and hi-quality care across the healthcare system.  

Sagility?? combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. We optimize the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. 

Leading industry analyst firms have consistently cited our service excellence, breadth of offerings, and ability to execute. The most recent being recognized as a leader for Healthcare Payer Operations in 2022 as a part The Healthcare Payer Operations PEAK Matrix® Assessment report by Everest Group. To learn more about our recognitions please visit our AWARDS SECTIONWe have 28,000 employees in 15 cities across 5 countries ? India, Philippines, USA, Jamaica,and Colombia.  

Job role and  key responsibilities

This role is initially to build and implement an effective Outpatient programs.  This position is responsible for setting up the audit program using program framework to develop rules to identify the claims for audit, create review guidelines and train the audit teams. Additional responsibilities include identifying and building concepts by reviewing CMS guidelines, policies and client specific criteria 

Key Responsibilities: 

·         Identify new concepts which have the savings potential for development and deployment. 

·         Drive specific measurable results with timely deployment of concepts 

·         Work with audit leaders and establish a process to ensure the concepts being deployed are working as expected with higher findings thus ensuring higher hit rates and findings rates on the concepts deployed. 

·         Ensure to create review guidelines for concepts deployed to ensure operations and audit staff have all the information they need to work the concepts. 

·         Continually identify and deploy new edits and algorithms to drive incremental savings 

·         Establish strong relationships with internal and external stakeholders to define, align and delivery payment accuracy initiatives 

·         Influence leadership to adopt new ideas, and products as an experienced industry leader. 

·         Develop analytics around concepts provided by internal or external sources with assistance from team members or direct supervision from development to production 

·         Review data requirements/design and implement logic to achieve data needs 

·         Implement and develop data concepts and monitor their impact 

·         Serves as a resource to operational claims and clinical staff, answering questions and assisting with department informatics, reporting and trending, and workflow/operational issues 

·         Provide executive level program updates and manage team escalations 

·         Comply with HIPAA Compliance and Security Policies and Procedures 

·         Facilitate innovation and continuous process improvement 


·         Bachelor?s Degree ? 

·         Active CPC/COC certification 

Required Skills and Experience 

·         5 years? experience in the health care industry (payer) 

Experience in performing medical records Review/ auditing claims 

·         2 years? experience in outpatient coding 

·         Strong Outpatient Surgery and Observation Coding/Auditing experience 

·         Sound knowledge of ICD-10-PCS/CM, CPT and HCPCs Coding Guidelines 

·         Expertise with Medicare LCDs and NCDs 

·         Expertise with NCCI Guidelines, OPPS, APC 

·         Excellent verbal and written communication skills 

·         Experience with encoder tools (3M, Webstrat, Optum, Truecode) 

·         Maintains working knowledge of CMS rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD-9/10 coding, HCPCS and DRGs)  

·         Should be able to effectively coordinate with the development team and Stake Holders 

Must be a team player and adaptable to a dynamic work environment 

·         Proficiency in SQL/ PLSQL will be an added advantage 

An ideal candidate should be: 

·         Keep abreast of industry trends and opportunities and apply best practice to payment integrity and claims processing 

·         Continually identify and deploy new edits and algorithms to drive incremental savings 

·         Ability to think analytically, apply analytical techniques and to provide in-depth analysis and recommendations to senior management using critical thinking and sound judgement 

·        Love collaborative environments that use agile methodologies to encourage creative design thinking and find innovative ways to develop with cutting edge technologies 

·        Proven interpersonal skills while contributing to team effort by accomplishing related results as needed 

Your life with us 

Sagility believes in Doing Right by its People.  

We believe in providing strong growth opportunities, multiple training programs to support your learning curve, exposure to large international clients and access to advanced technologies and solutions at your disposal - so that you can focus on making a difference through your role.  

We are an inclusive, open, and welcoming organization where our people are at the heart of everything that we do. We believe in giving back to the local communities in which we operate. We have strong rewards and recognition platforms, programs where your ideas can turn into reality.  

We respect the need for a composite life and to encourage the same, we have employee friendly leave policies for the much needed down time and a lot more. Our medical insurance coverage is one of the best in class, covering you and your family when you need it. Last but not the least, we have lots of fun everyday through our wellbeing programs, talent shows, engagement activities - it?s an endless list! 

Apply For This Job Back