AGM/ General Manager | Quality Analyst (RCM Healthcare)

Asprcm Solutions

10 - 16 years

0 - 1 Lacs

chennai

Posted:3 weeks ago| Platform:

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Skills Required

revenue cycle management us healthcare denial management quality assurance medical billing

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Job Type

Full Time

Job Description

Job Title:

Quality Analyst

Experience: 10+ Years

Job Summary

The AGM/GM QA (RCM Healthcare) will lead and manage the Quality Assurance function for RCM operations (billing, claims, AR follow-up, collections, denials management, etc.). The role ensures that all RCM processes meet defined quality standards and regulatory/compliance requirements, drives continuous improvement, enforces adherence to SOPs, and leads a team of QA professionals to maintain high accuracy, efficiency, and service quality.

Key Responsibilities

Design, implement, and manage a comprehensive QA framework for all RCM operations billing, AR follow-up, denials, appeals, collections etc.
Define and enforce QA standards, evaluation metrics, and audit policies/ procedures.
Plan and oversee regular and ad-hoc audits of RCM workflows to ensure compliance, accuracy, and adherence to SLAs.
Conduct root cause analysis (RCA) of identified quality issues e.g. billing/claim errors, denial trends and lead corrective and preventive action (CAPA) initiatives.
Develop, maintain, and update Standard Operating Procedures (SOPs), process documentation, QA guidelines, workflows and quality-related process documents.
Prepare and deliver regular quality reports, dashboards, and metrics to senior management including error detection rates, claim accuracy, denials analysis, audit findings, trend reports, improvement plans.
Mentor, coach and manage a QA team; define training needs, provide feedback, conduct calibration sessions, performance reviews. careers.
Lead continuous improvement initiatives process optimization, workflow redesign, quality enhancement programs to improve turnaround times, reduce errors/denials, enhance accuracy and client satisfaction.

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Asprcm Solutions

Technology

San Francisco

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AGM/ General Manager | Quality Analyst (RCM Healthcare)