Quality Analyst - Authorization RCM

Location: Bangalore, Karnataka / Tiruchirappalli (Trichy), Tamil Nadu

Job Summary

We are seeking a detail-oriented and analytical Quality Analyst (Authorization) to monitor and evaluate processes related to healthcare authorizations or general business process outsourcing (BPO) operations. The ideal candidate will ensure that all activities meet internal quality standards, industry regulations (e.g., HIPAA), and client expectations, thereby minimizing errors and improving overall operational efficiency.

Key Responsibilities

• Monitor and Review:

  Regularly audit authorization requests, documentation, and agent/processor interactions (calls, emails, data entries) to ensure accuracy and compliance with established guidelines.

• Identify and Document:

  Pinpoint issues, deviations, or process gaps and log them meticulously in tracking systems (e.g., Jira, internal databases).

• Analyze and Report:

  Conduct root cause analysis for recurring quality issues and generate detailed reports/dashboards on key quality metrics and performance trends for management and stakeholders.

• Ensure Compliance:

  Verify that all procedures adhere to relevant industry standards and regulatory requirements (e.g., medical coding guidelines, data privacy laws).

• Provide Feedback and Training Support:

  Collaborate with team leaders and management to provide clear, constructive feedback and support the development of training materials to improve team performance.

• Process Improvement:

  Recommend and assist with implementing preventative and corrective actions and process enhancements for higher accuracy and efficiency.

• Collaboration:

  Work effectively with cross-functional teams, including operations, compliance, and IT, to resolve quality-related issues.

Required Skills and Qualifications

• Experience:

  1-3 years of experience in a Quality Analyst, auditing, or similar role, preferably within a healthcare, medical billing, or BPO environment.

• Attention to Detail:

  Meticulous and thorough approach to reviewing complex information and data.

• Analytical Skills:

  Strong ability to assess problems, analyze data, and identify patterns and solutions.

• Communication:

  Excellent verbal and written communication skills to effectively report findings and provide feedback.

• Technical Proficiency:

  Familiarity with quality assurance tools, audit software, CRM platforms, and strong knowledge of MS Office/Google Workspace (especially Excel for data analysis).

• Industry Knowledge:

  Understanding of relevant industry-specific knowledge (e.g., medical coding, insurance claim lifecycles, HIPAA regulations) is a significant plus.