Healthcare Outsourcing

Julius Raj Stephen, Joint Head of Operations, Omega Healthcare Management Services Pvt. Ltd., India

Successful implementation of ICD - 10 and the growing needs & challenges of medical coding & billing in India are highlighted in this interview.

1. Prior to conceptualising Omega Healthcare in 2004, you had a sizeable amount of experience within the realm of Healthcare Outsourcing. Kindly shed some light on your journey thus far.

I started my career in early '96 as a Charge Entry, Payment Posting Executive. A good schooling from Kendra Vidyalaya, that moulded my communication skills, was the key factor that paved way for my long stint in this industry. This, and my desire to learn more about Revenue Cycle Management (RCM), put me on to the next role as an AR Executive. Each day was a new learning, communicating directly with customers and the providers. This role helped gain a thorough understanding of the functionality of the RCM business process.

At a time when healthcare outsourcing was in its infancy in India, being a part of healthcare outsourcing industry was akin to being in the midst of a vast ocean of knowledge. I was determined to charter my career in tandem with the growth of the industry. Starting out as an executive to being a team lead and thereafter an Account Manager, these varied roles have taught me the nuances of healthcare outsourcing, strategies to leverage its advantages and how all these were packaged into a successful business model. I have seen and been part of the continuous transition this industry has been through.

I joined Omega Healthcare in 2003 as an Assistant Manager. My journey here has been remarkable and has further enriched my knowledge on the healthcare BPO industry. With two decades of experience, I can see how the USP in the healthcare outsourcing sector has evolved from competitive pricing to Value Adds – it is no longer about the monetary benefits alone. As a service oriented industry, success stories have now become about customer delightment and going the extra mile. Today as the Joint Head of Operations for Omega, it fills me with immense pride to be a part of an organization that staunchly abides by this principle. A 13 year journey, that continues, has been remarkable and the amount of knowledge being gained in the process is truly phenomenal and valuable.

2. Your organisation’s mission clearly postulates that it doesn’t intend to deal with physicians and hospitals directly. What is the ideology behind this practice?

To quote our founder Anurag Mehta, “The most important differentiator of our company is the fact that we don’t compete with our clients, and what I mean by that is we are a wholesale type of company as opposed to retail”. Partnering with our aggregator clients and growing together has been the reason for our success. It would be against our ethical business practice to directly work with physicians and hospitals, which could possibly result in business conflict as well. Working primarily in the US healthcare sector, this policy has worked well for us in gaining a wide clientele.

3. As the Joint Head of Operations, would you say that administering an organisation across variegated geographical zones has its fair share of challenges?

We are constantly locating at expanding our facilities in each of the locations. One would not feel any difference in the culture and atmosphere across our locations. Tier-2 and Tier-3 cities did prove to be a challenge for us, given the conservative culture of these places. But with continuous coaching and mentoring, we have helped these places strike a balance and sync with our corporate values and culture. The induction and on-boarding process, especially, follows a uniform process and has been of immense help to the new employees settle in to our “Omega Family”. As an organization, we establish and strive to maintain a standard across our locations, be it the infrastructure, culture, values, or the basic modality of operations.

Adding to this, we have real time dashboards and good reporting by the work force management team. Omega has invested heavily on good data analytics and BI tools which makes my job easier.

4. How efficacious are your training programmes as well as facilities in terms of shaping up the potential generation of Healthcare outsourcing leaders? Please delineate the workings of the Omega Medical Coding Academy.

At Omega, we believe in creating strong leaders. Learning and skill building is our core DNA. Our culture strongly advocates & encourages associates to keep learning on a continuous basis. Our training programs are designed to create this pool of business& domain savvy professionals. This is done through a series of industry recognised, domain certification programs, and business acumen programs. CPC certification in partnership with AAPC, ‘First Time Leader’ &‘First Time Manager’, are a few examples of our training programs.

Based on our tie ups with AAPC and Gallup, our programmes are delivered using the most modern learning science like ‘multiple learning intelligence’, ‘strength based learning’ etc. We use some of the most modern learning delivery methodologies like ‘4-stage learning architecture’, ‘Outcome based instruction models’. These programs are designed using methodologies like ‘ADDIE / SAM’ to ensure agile learning and outcome aligned to the business requirements.

Our associates have a wide range of opportunities to choose from and can learn either via an instructor led or web based, self-learning model. Social learning is a part of our agenda in the months to come to pioneer different learning styles in this industry.

All these efforts pay off;and the proof of the pudding lies in the fact that over 70 per cent of our top leadership is organically grown over a period of 12 years. Ex-Omegans also hold key positions in other organisations in the healthcare Industry. Clients onsite peg Omega at the top of the line on domain & delivery of their projects.

Omega Medical Coding Academy (OMCA) is a division of Omega Healthcare — the preferred BPO partner to the US healthcare industry, OMCA is the brain-child of Mr. Gopi Natarajan, created to leverage Omega Healthcare Management Services’ (OHMS) vast experience and benefit both students and the industry in general. This first-of-its-kind business-academia collaboration will deliver high-calibre professional medical coders to cater to the expanding industry.

With highly-qualified trainers having extensive experience, OMCA will continue to tap the huge base of graduates emerging from educational institutions, and help India become a force to be reckoned with in outsourced healthcare services. OMCA certification provides fresh graduates with the opportunity to work on critical processes for Fortune companies in the US.

5. Is your Data Management service integral part of the holistic group of healthcare outsourcing solutions that you do offer? Does data validation play a big part in this service?

We don’t do any data management services to our clients. All the data which includes coding, billing and PHI sits in client system.

6. What are the challenges that you face while endeavouring to deftly carry out medical billing and coding for multifarious organisations and businesses?

Maintaining 98 per cent quality of service delivery to each and every single client is by far the biggest challenge in any service sector. It is an even bigger challenge in the healthcare sector where one has to handle critical information such as PHI and insurance claims. There is a perennial demand for trained and skilled workforce in this sector. The need of the hour is a curriculum that not only imparts the requisite training and education, but also nurtures and moulds the young talent. This curriculum should also empower them with necessary communication skills to be more customer-centric and engage in a collaborative service delivery business culture.

The transition from ICD-9 to ICD-10 was smooth, even though the industry overestimated the difficulty of the transition. We invest significantly in training all our people and stay up to date with the industry standards. Since any change will take time, we had more employees to offset any drop in productivity and that helped. These efforts stood out and even today we have very little attrition, despite attempts of poaching by competitors. It was a big change and we have been well prepared, way ahead of the competition. As a result, we were able to grab opportunities much faster than the others. We plan to add over 1,000 coders to our rolls this year.

7. Considering the dynamic nature of regulatory policies and government rules, is there a vast possibility of error when it comes to insurance?

When it comes to insurance claim processing, there does exist a possibility of errors which results in claims being processed incorrectly (denied, overpaid/underpaid). On the basis of sample taken we have 3 per cent to 4 per cent of claims being processed incorrectly by insurance payers on an average. In order to get these erroneous claims identified and corrected, we utilise automated reports built into our systems and seasoned claim analyst who have been specifically trained to study system reports, identify the issues and take the appropriate corrective measures. These two mechanisms have immensely helped us to keep a check on our insurance claim errors.

8. What are the prospective strategies that Omega Healthcare plans to execute in order to ensure an enduring growth in the imminent years?

On the business front, we are growing at about 30 – 35 per cent and will further this momentum over the next 3-5 years. We have doubled our turnover over the last two and half years; you can imagine the kind of growth we have been achieving.

It is important to have a rich and healthy workforce in any organization for the company’s stability and scalability. Thus, building an HR structure that is aligned to the business structure and well positioned to service the needs of business is vital to any organization. It also requires designing jobs in a manner that promotes accountability as well as professional development. At Omega Healthcare, we constantly design and implement effective people processes, building capabilities in all the functional areas of HR like staffing, on-boarding, performance management, rewards, talent development, employee engagement and so on. Recently, we launched Parivarthan, an employee assistance programme, aimed at providing counselling and wellness services to help our people to deal with various issues. It is one of the many holistic HR approaches taken by Omega that can have a lasting impact on employees’ lives.  Today, at Omega we are about 10,200 people and continue to grow.

                                                                                                                                                                                                                                                                           -- Issue 34 --


Author Bio

Julius Raj Stephen

Julius is one of the founding members of Omega Healthcare and has played a crucial role in Omega’s growth–right from its early days as a start-up to its current position of dominance. He presently leads the operations team spread across multiple geographies. Julius brings with him a customer-centric approach and a track record of increasing revenues and reducing cycle time. He leverages vast process knowledge in revenue cycle management to enhance efficiencies, improve quality and boost productivity for clients.

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