Manager

Position – Manager Quality Assurance

Department – Revenue Cycle Management

Shift – India Mid Shift/Flexible Timing

Work Location: Remote/Hybrid Model (When required to travel to Chennai)

Key Responsibility:

• Internal and external Stakeholder Management
• Heading the RCM Quality vertical independently
• Driving Quality vertical in cost effective manner
• Migrations/Setup start-up projects for any new clients
• Strategizing, Planning and Execution of the RCM Quality vertical framework
• Client relationship Management
• Process and people related change Management
• Expertise in RCM Training related Reporting & MIS

Job Responsibility:

• Apply quality assurance expertise by closely monitoring trends, identifying transactions and processes for audits, presenting audit outcomes and recommendations to mitigate gaps to the operations team for resolution
• Work closely with operational teams to resolve process ambiguity by calibrating on audit process and parameters
• Build strong customer relationships and deliver customer centric solutions
• Identify opportunities to enhance/improve workflows to ensure efficient, productive, and successful processes are established for payment posting and accounts receivable
• Ability to identify when a function/action was performed that is not included in Standard Operating Procedures (SOPs)
• Utilize audit results to report trends and recommend training as applicable
• Accountable for analyzing and measuring results of implemented policies, changes, and system modifications
• Establish and implement interim workaround solutions as needed and communicate to all impacted users
• Review customer feedback/concerns and ensure that corrective action is being taken, adhering to the plan of action
• Addresses challenging situations by remaining open to alternative views
• Demonstrates a strong drive to achieve meaningful results
• Assist in monitoring Service Level Agreements (SLA)
• Perform additional projects and job duties as assigned
• Develop and enforce QA standards and evaluation metrics.
• Lead the QA team to ensure timely audits, compliance, sampling and adherence to quality protocols
• Develop and share quality reports, RCAs, develop and deploy corrective and preventive action plans
• Ensure process meets quality standards consistently
• Provide recommendations on personnel performance and training needs.
• Mentor QA staff and drive a culture of accuracy and improvement.
• Track and report key quality metrics using analytics tools.
• Establish real-time monitoring dashboards and share insights with leadership
• Conduct root cause analysis to identify systemic issues and improve workflow efficiency.
• Publish weekly dashboards and monthly reports for clients

Qualification/Requirement and Skillset:

• Bachelor’s degree in healthcare administration, Business Administration, or related field preferred. Graduation mandatory, master’s in business administration will be preferred
• Overall 10+ years of related RCM experience on front to back processes
  1. Complete hands-on experience in all RCM front end, middle end and back-end processes
• 5+ years auditing experience in a US RCM healthcare setting
  1. Should have Quality Lead/Manager in previous organization on paper
• Six Sigma certified from a reputed company/certifier- (min green belt) – This is not mandatory, however candidates with LSSGB will be preferred
  1. Implementation of all Quality SS in current process/project
• Self-motivated; you are a person who takes initiative and approaches problem solving with creativity and excitement
• A collaborator with excellent interpersonal skills who can work seamlessly with various teams and levels in the organization
• Highly organized and can hold yourself to a deadline
• Strong analytical skills
• Strong proficiency in Microsoft Office Suite, specifically Excel, Word, and PowerPoint
• Should be able to travel to Chennai Service Delivery location as and when required

Key Performance Indicators (KPIs):

• Error Detection: Identify 100% of critical errors and 95% of non-critical errors
• Root Cause Analysis: Complete analysis of all identified errors within five business days
• Process Improvement: Implement SOP updates for all recurring errors
• Team Recommendations: Provide actionable feedback within Two business days
• Error Reduction: Achieve a 50% reduction in recurring errors within 45 days
• Claim Accuracy Rate: Maintain a minimum of 98% claim accuracy rate for all RCM functional processes
• Timeliness: Complete audits and provide feedback within 48 hours