Job Description
RESPONSIBILITIES
Lead and drive overall quality strategy across end-to-end RCM functions
Define and implement quality frameworks, SOPs, and audit mechanisms aligned with client and regulatory standards
Ensure compliance with CMS, HIPAA, provider guidelines, and industry regulations
Establish strong governance models, KPIs, and quality scorecards for performance tracking
Drive continuous quality improvement initiatives using RCA, Six Sigma, and Lean methodologies
Identify trends in denials, errors, and audit failures and implement corrective actions
Manage internal & external audits, ensuring audit readiness and compliance adherence
Partner with operations teams to reduce rework, improve accuracy, and enhance first-pass yield
Lead client quality reviews (QBRs) and act as the point of contact for quality-related escalations
Ensure client SLA adherence, service excellence, and long-term retention
Build and manage high-performing QA teams, including h...
Lead and drive overall quality strategy across end-to-end RCM functions
Define and implement quality frameworks, SOPs, and audit mechanisms aligned with client and regulatory standards
Ensure compliance with CMS, HIPAA, provider guidelines, and industry regulations
Establish strong governance models, KPIs, and quality scorecards for performance tracking
Drive continuous quality improvement initiatives using RCA, Six Sigma, and Lean methodologies
Identify trends in denials, errors, and audit failures and implement corrective actions
Manage internal & external audits, ensuring audit readiness and compliance adherence
Partner with operations teams to reduce rework, improve accuracy, and enhance first-pass yield
Lead client quality reviews (QBRs) and act as the point of contact for quality-related escalations
Ensure client SLA adherence, service excellence, and long-term retention
Build and manage high-performing QA teams, including h...