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Job Summary By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare. Quality Manager will be responsible for driving process audits, excellence, reducing inefficiencies and improving the accuracy of payment cycle to achieve highest standards of quality and compliance in the RCM operations. Will also assist Leadership with continued training, education and ongoing action plans to ensure quality is consistently met for existing teams in partnership with Training and the Leadership Team. Job Competencies Decision Making - Makes decisions by gathering, analyzing, and interpreting information. Chooses the best course of action by establishing clear decision criteria, generating and evaluating alternatives, and making timely decisions. Courage - Proactively confronts difficult issues and effectively participates in challenging conversations; makes hard choices and takes bold action in the face of opposition or fear. Refuses defeat. Influencing - Uses effective persuasion techniques to gain acceptance of ideas and commitment to actions that support specific outcomes. Coaching & Developing Others - Partners with individuals’ and supports their development of knowledge, skills, and abilities; empowers them to unlock their potential and maximize performance and growth knowing that developing you makes us better. Emotional Intelligence - Establishes and sustains trusting relationships by accurately understanding and interpreting one’s own and others’ emotions and adapts behaviors to accomplish intended results. Creating an Inclusive Environment - Makes decisions and initiates action to ensure that policies and business practices leverage the capabilities and insights of individuals with diverse backgrounds, cultures, styles, abilities, and motivation. Takes Initiative - Takes prompt action to accomplish goals and achieve results beyond what is required, is proactive and pursues relentlessly. Essential Job Functions Customer Obsession - Consistently provide exceptional experience for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas - Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence - Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results. Develop and implement quality monitoring programs across various RCM functions, including charge entry, coding, billing, payment posting, AR follow-ups, and denials management Conduct data-driven root cause analysis to identify errors, inefficiencies, and compliance risks in RCM workflows Implement smart audit frameworks to track quality KPIs and error trends, leveraging automation and anomaly detection Identify and eliminate non-value-added (NVA) steps in RCM workflows to improve productivity and reduce turnaround time Develop and maintain automated dashboards to monitor key performance indicators (KPIs) across claims processing, denials, AR follow-ups, and payment posting Perform trend analysis on denials, payment delays, and claim rejections, identifying patterns to improve first-pass resolution rates Monitor SLAs, turnaround times, and accuracy rates, providing insights to leadership for strategic decision-making Generate monthly and quarterly reports for senior management, offering insights into quality trends, efficiency improvements, and risk areas Lead Lean projects to streamline RCM operations and reduce rework. Implement continuous improvement initiatives like Kaizen, PDCA, DMAIC to enhance efficiency in billing, Cash and AR follow-ups Work with IT and automation teams to design rules-based audit processes to reduce manual touchpoints Establish opportunities to track and improve efficiency on KPIs & SLAs such as first-pass claim resolution rate, denial rates, appeal success rates, and rework percentages Ensure compliance with payer guidelines, HIPAA, CMS regulations, and internal SOPs to minimize financial risk Stay updated with changes in the Healthcare/RCM industry and ensure we implement the same This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation. Interested candidate please share resume suganya.mohan@yitrobc.net Show more Show less
