RCM Quality Analyst

About the Role:

Quality Analyst with proven experience in U.S. Healthcare Revenue Cycle Management (RCM)

Key Responsibilities:

• Conduct quality audits for RCM functions, including Eligibility, Authorization, Charge Entry, Claims Submission, Payment Posting, Denial Management, and AR Follow-up
• Analyze test requirements and perform functional, regression, and end-to-end testing on healthcare billing applications
• Validate HIPAA-compliant claim files, payer rules, CPT/ICD code mapping, and insurance-specific workflows
• Perform backend data validation using SQL to ensure data integrity across billing and financial records
• Identify errors, audit trends, and training needs to improve team performance and billing accuracy
• Generating comprehensive reports on quality performance and sharing feedback with team members on a weekly or monthly basis.
• Collaborate with cross-functional teams, including operations, training, developers, and business analysts, to support process enhancements
• Track and report key quality metrics, driving continuous improvement initiatives
• Ensure compliance with HIPAA, CMS, and U.S. healthcare payer regulations
• Support UAT and production validations for new releases and billing system updates
• Lean Six Sigma (Green Belt / Black Belt): For reducing errors, improving workflows, and driving operational efficiency.
• Certified Quality Auditor (CQA) – ASQ: For professionals conducting audits of quality systems and processes.
• Project Management Professional (PMP): For managing cross-functional QA and system improvement projects.
• Certified Health Data Analyst (CHDA) – AHIMA: For analyzing healthcare data to improve billing and QA outcomes.
• SQL/Data Analytics Certifications (Microsoft, Oracle, Coursera): For backend validation and reporting.

Required Qualifications:

• 1–5 years of hands-on QA or auditing experience in

  U.S. Healthcare RCM and medical billing

• In-depth knowledge of

  end-to-end RCM workflows

  : Eligibility, Authorization, Coding, Claims, Denials, and AR
• Solid understanding of

  HIPAA

  and healthcare data privacy standards
• Excellent attention to detail, communication, and analytical skills
• Experience with billing or practice management platforms (e.g.,

  Kareo

  ,

  AdvancedMD

  ,

  eClinicalWorks

  ,

  Athena

  ,

  Epic

  , or

  Cerner

  ) and also in payor portals

Why Join Us:

• Opportunity to work with a dynamic team of professionals and achieve growth and expertise in your chosen field.
• Competitive salary, bonuses, and comprehensive benefits package.
• Ready to take your design and development game to the next level? Join us!