Quality Manager (US Healthcare Medical Billing)

Qualifications:

• Must have a strong background in US Healthcare Revenue Cycle Management (RCM) with expertise in auditing Demo & Charges, Payment Posting, Denial/AR Management, including process audits.
• Minimum 5 years of experience in a team management role.

Roles and Responsibilities:

• Manage a team of 15-20 Quality Experts to ensure quality outcomes aligned with SLAs.
• Conduct audits, prepare reports, and perform detailed analysis to uphold quality standards.
• Collaborate with cross-functional teams (Operations, Training, etc.) to address process gaps and implement action plans.
• Drive client and internal calibrations to align quality metrics with expectations.
• Monitor and present process and business performance dashboards to internal and external stakeholders, including senior management.
• Perform end-to-end business diagnostics to identify risks, gaps, and areas for improvement.
• Plan resource allocation and execute the QA framework effectively.
• Facilitate ideation sessions to foster innovation and process enhancements.
• Coach and guide the team to achieve deliverables, including PKTs, audits, and regular team engagements.

Key Skills:

• Expertise in auditing key RCM processes (Demo & Charges, Payment Posting, Denial/AR Management).
• Strong coaching, feedback, and mentoring capabilities.
• Analytical skills to identify process gaps and propose actionable improvements.
• Advanced report management and data interpretation abilities.
• Proficiency in numerical and statistical analysis.

Note: Candidates without experience in the US Healthcare Medical Billing domain are requested not to apply for this position.