QA Manager (RCM)

Job Summary:

The Quality Assurance Manager will be responsible to lead and enhance QA processes within Revenue Cycle Management (RCM), ensuring accuracy, compliance, and continuous improvement.

Key Responsibilities:

• 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

Key Performance Indicators (KPIs):

• Error Detection: Identify 100% of critical errors and 95% of non-critical errors.
• Root Cause Analysis: Complete analysis for 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 99% claim accuracy rate.
• Timeliness: Complete audits and provide feedback within 48 hours.

Qualifications:

• Bachelors degree.
• 10+ years of experience in RCM or healthcare, with 7+ years in leadership in QA processes.
• Comprehensive knowledge of end-to-end RCM, including billing, coding, and claim management.
• Expertise in QA methodologies, Six Sigma, or Lean principles.
• Proficiency in QA software, RCM systems, and data analytics tools.
• Strong analytical, communication, and problem-solving skills.
• Proven ability to manage and mentor teams effectively.