The Healthcare industry entails a large number of services including medicalcoding, account receivables, denial management, correspondence management, data conversion and so on.  According to Tony Mira- Founder and CEO of Ajuba Solutions, graduates with exposure to medical science are best sought after in this field as well as abroad.

In this interview with Careers360, Mr. Mira talks about the healthcare management industry- what it entails, the educational opportunities and the prospects one can explore in this industry.

Below are the edited excerpts:

Q: Tell us about Healthcare Outsourcing. What does the field entail?

A: Healthcare Outsourcing as the name suggests is a process by which healthcare organizations outsource certain services that are considered to be intrinsic to managing their core business. One major chunk of this business is Healthcare Revenue Cycle Management (RCM) - a process that helps simplify the healthcare ecosystem right from servicing to billing.

A major contributor of growth to this industry is the US healthcare.  Constant evolution in terms of systems and practices coupled with the dynamic regulatory framework has raised the pedestal for outsourcing worldwide. A huge promise that comes along with this for India are the revenues generated from off shoring this segment to the Indian BPO industry and the subsequent increase in employment.

The industry entails off shoring a large number of services like medical coding, account receivables, denial management, correspondence management, mailroom services, data conversion, claims process and adjudication, member enrollment and eligibility services that helps simplify patient data management at hospitals and physician chains in the US.


Q: What are the educational opportunities in healthcare outsourcing?

A: Healthcare Outsourcing has opened doors to a diverse educated force right from graduates with an exposure to medical and life science to mathematics to healthcare professionals pursuing different careers. That said there still is a lacuna  amongst institutes today to offer specific graduate courses for medical coding or analytics in India. It is on a corporate level that organisations have incorporated training modules to equip their employees with industry-based skill sets.

The industry is at a situation where there is a high demand for specialized talent than there is availability. Therefore, organisations are today ready to invest in campuses to train the talent interested in being part of this growing industry. Organisations are also looking at partnering with institutions to mould industry-ready talent to meet the growing demand for specialised healthcare profiles.


Q: Are there specific courses designed for students wanting to explore this field?

A: There is no specific course that has been designed for this industry as such. Well, this also acts as a big advantage for aspiring talent. Any graduate with an exposure to medical science is best sought after in this field since medical coders are in great demand in India. With the recent collaboration and boom of analytics in healthcare, candidates who have majored in mathematics are also sourced as they form effective analysts.


Q: Can you highlight the career opportunities in healthcare outsourcing in India as well as abroad?

A: Rated as a growing field with a CAGR of about 14.6 % by 2016, the healthcare business process management market is indeed a promising field for upcoming graduates. Owing to the advances in the U.S. healthcare information management system (HIMS), the demand for capable IT specialists from India is growing constantly. The upcoming ICD transition that is expected to be the next milestone in healthcare patient management is opening up plethora of opportunities for medical coders both in India and abroad. Considered as the core to healthcare outsourcing, Medical Coding is definitely a career that is the in- thing.

Apart from coders, experts in project management and programme management are also highly in demand. The adoption of high end technology for information processing and the collaboration of analytics in healthcare have consequently raised the need for analysts today.

What is outsourcing without voice calls? Yet another great opportunity in the healthcare BPM industry are for candidates who have graduated from the arts and science verticals with good communication and interpersonal skills. Other healthcare profiles like physiotherapists, nurses, general physicians, ayurvedic and homeopathic practitioners are also sourced in the healthcare BPM sector to specialize in medical writing, biostatics etc.


Q: What are the factors that an aspirant should consider before embarking in this field?

A: The world of healthcare outsourcing undergoes constant changes with several developments pertaining to the healthcare segment in the US. That said, an aspirant would need to work towards becoming proficient in Medical Coding, Medical Billing and HIPAA Compliance. Typically this can be achieved through standard certifications such as a CPMB Certification. A number of institutions are offering such certifications. Since medical coding is a niche segment which involves translation of medical terms into alphanumeric codes, one would need to have strong analytical skills, with attention to detail. Needless to say, strong computer skills is a must.


Q: What are the areas of specialization in healthcare?

A: Healthcare as an industry is highly specialized both in terms of processes as well as talent. Owing to high levels of accuracy and confidentiality in managing patient data, the industry functions in a highly regulated environment defined by government norms especially when it comes to the US and the Europe healthcare systems. That said, the areas for specialization in healthcare include medical coding, medical writing, bio-statics, healthcare and data analytics.

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