Job Summary
We are seeking an experienced Quality SME / Senior Quality SME to lead quality initiatives across US Healthcare RCM operations. The ideal candidate will have extensive experience in quality auditing, process improvement, root cause analysis, client compliance, and mentoring quality teams.
The role requires strong domain expertise in US Healthcare Revenue Cycle Management, excellent analytical skills, and the ability to drive continuous improvement while partnering closely with Operations, Training, and Leadership teams.
Key Responsibilities
- Lead quality assurance activities across multiple US Healthcare RCM processes.
- Perform detailed quality audits and ensure adherence to client-specific guidelines and internal quality standards.
- Analyze audit findings, identify quality trends, and implement corrective and preventive actions (CAPA).
- Prepare and present quality dashboards, scorecards, and MIS reports to management and clients.
- Conduct calibration sessions with Operations, Clients, and Internal Quality teams to ensure scoring consistency.
- Develop, review, and maintain SOPs, quality parameters, audit checklists, and process documentation.
- Coach Team Leaders, SMEs, and agents through feedback sessions and quality improvement plans.
- Ensure compliance with HIPAA regulations, payer guidelines, and client requirements.
- Support client audits, internal audits, and process transition activities.
Required Skills
- Strong understanding of the US Healthcare Revenue Cycle Management process.
- Knowledge of Medical Billing, AR Calling, Payment Posting, Charge Entry, Eligibility Verification, and Denial Management.
- Proficiency in Microsoft Excel and reporting.
- Knowledge of HIPAA compliance and healthcare documentation standards.
Qualifications
- Bachelor's degree in any discipline.
- Minimum 3–6 years of experience in US Healthcare RCM.
- At least 2 year of Quality Analyst/Specialist experience preferred.
- Experience in medical billing quality auditing is highly desirable.
Preferred Experience
Experience auditing any of the following processes:
- Medical Billing
- Accounts Receivable (AR)
- Denial Management
Pay: ₹40,000.00 - ₹50,000.00 per month
Benefits:
- Commuter assistance
- Food provided
- Provident Fund
Ability to commute/relocate:
- Sahibzada Ajit Singh Nagar, Mohali, Punjab: Reliably commute or planning to relocate before starting work (Required)
Experience:
- Quality audits: 2 years (Required)
Location:
- Sahibzada Ajit Singh Nagar, Mohali, Punjab (Required)
Work Location: In person
