Manager

Job Description

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 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 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 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 Show more Show less