Immediate Opening For QA Director - RCM

Greetings from Legacy Health Pvt Ltd

We have an Immediate Opening for QA Director (US Healthcare)

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Job Profile

• Develop and implement a comprehensive quality assurance strategy aligned with organizational goals and RCM industry best practices.
• Define and track Key Performance Indicators (KPIs), SLAs, and quality benchmarks for all RCM processes.
• Oversee internal audits of coding, billing, collections, and other RCM operations.
• Ensure compliance with HIPAA, CMS guidelines, payer-specific rules, and other applicable regulations.
• Collaborate with compliance teams to implement corrective actions based on audit findings.
• Identify trends, root causes, and opportunities for process optimization using data and feedback.
• Lead Six Sigma or Lean projects to streamline RCM workflows, reduce denials, and improve first-pass resolution rates.
• Lead and mentor a team of QA managers, auditors, analysts, and trainers.
• Develop QA training materials and programs for onboarding and continuous staff education.
• Promote a culture of quality ownership throughout the organization.
• Work closely with operations, IT, client services, and leadership teams to support cross-functional initiatives.
• Participate in client meetings and business reviews to provide quality updates and ensure client satisfaction.
• Provide regular reports on QA metrics, audit outcomes, and improvement initiatives to executive leadership.
• Use data to guide decisions and drive transparency around quality performance.

Qualifications:

• 12+ years of progressive experience in RCM operations with at least 5 years in a QA leadership role.
• Strong knowledge of medical billing, AR follow-up, and payer regulations.
• Familiarity with RCM platforms and QA tools.
• Excellent communication, leadership, and analytical skills.
• Experience in offshore/onshore delivery models.
• Knowledge of automation tools and AI-based QA systems.
• Prior experience with enterprise healthcare clients or large provider groups.

Interested candidates can reach out to Anitha 7094338825 / Swetha - 8925809054 anitha.arumugam@legacyhealthllc.com/Swetha.Sekar@legacyhealthllc.com