Subject Matter Expert (SME) in US Healthcare EHR & RCM

About the Company

Humworld Solutions Private Ltd. is a software product development firm specializing in the healthcare sector. The company focuses on creating and maintaining Remote Care Management programs and Electronic Health Record (EHR) systems.

Key Responsibilities

• Define essential functional requirements for Electronic Health Record (EHR) and Revenue Cycle Management (RCM) software modules.
• Design efficient workflows encompassing patient scheduling, clinical charting, and electronic prescribing processes.
• Architect comprehensive medical billing workflows, spanning from charge capture to clearinghouse interactions.
• Lead engineering teams by providing guidance on claim scrubbing, ERA/835 transaction processing, and denial management strategies.
• Conduct thorough testing of workflows, modules, and user interface screens, including hands-on creation of test cases.
• Ensure product adherence to regulations such as HIPAA, MIPS, MACRA, and programs like Meaningful Use/Promoting Interoperability.
• Oversee integration of interoperability standards including HL7, FHIR, and EDI X12 transactions (e.g., 270/271, 837P/I, 835).
• Maintain current expertise in clinical coding systems such as ICD-10, CPT, HCPCS, and LOINC codes.
• Translate complex US healthcare regulations into clear, actionable technical user stories for development teams.
• Validate software through rigorous testing scenarios covering clinical and financial use cases.
• Serve as the chief consultant for the development, product management, and client onboarding teams, ensuring alignment and clarity.

Candidate Profile

• Possess any undergraduate or postgraduate degree in Allied or Health Life Sciences, such as BSMS or BAMS.
• Have between 5 to 7 years of professional experience in US healthcare software development or product management.
• Demonstrate profound technical expertise in ambulatory or inpatient Electronic Health Record workflows.
• Have practical experience managing both institutional and professional medical billing cycles.
• Show proven capability in handling EDI clearinghouse integrations and ANSI X12 standards.

Skills and Knowledge

• Strong comprehension of value-based care models and associated payer reimbursement policies.
• Ability to map and analyze complex healthcare data environments and database architectures for analytics purposes.
• Excellent communication skills to effectively convey healthcare compliance requirements to software engineers.
• Familiarity with major EHR platforms like Epic, Cerner, DrChrono, and eClinicalWorks is advantageous.

Preferred Certifications

• Certified Professional Biller (CPB) or Certified Professional Coder (CPC).
• Certified Coding Specialist (CCS).