- Role Purpose
The Senior Director / AVP – Quality & Compliance is the single accountable leader
for the quality assurance ecosystem and regulatory compliance posture across all
Revenue Cycle Management operations delivered from the India center. The role
exists to guarantee that every transaction — from patient access and coding
through billing, A/R follow-up, payment posting and denial management — meets
the accuracy, integrity and regulatory standards expected by US healthcare clients
and mandated by HIPAA, CMS and payer requirements.
This is a strategic and client-facing role. The incumbent owns the quality narrative
in client governance forums, drives a measurable zero-defect culture, and serves as
the bridge between India operations and US client quality and compliance
counterparts.
- Principal Accountabilities
Quality Management System (QMS)
Own, design and continuously evolve the end-to-end Quality Management
System across all RCM sub-processes — eligibility & benefits, charge capture,
medical coding, claims submission, A/R follow-up, denials & appeals, payment
posting and credit balances.
Define audit methodologies, sampling models, scoring rubrics, error
taxonomies and weightages aligned to client and regulatory expectations.
Establish multi-layered audit governance: transactional audits, process audits, compliance audits and pre-bill / pre-payment quality gates.
- Own the compliance framework aligned to HIPAA Privacy & Security Rules,
- CMS billing guidelines, OIG Work Plan, NCCI edits, payer-specific policies and
- applicable state regulations.
- Maintain the compliance risk register; conduct periodic risk assessments and
- lead remediation of identified gaps.
- Lead readiness for client audits, SOC / ISO / HITRUST assessments and
- external regulatory reviews.
- Governance & Client Engagement
- Own the Quality Scorecard and present monthly reviews and Quarterly
- Business Reviews (QBRs) to US client leadership with trends, RCA findings and
- Run calibration sessions with US client quality counterparts to keep audit
- alignment and reduce scoring variance to under 5%.
- Act as escalation owner for all quality- and compliance-related client
- Continuous Improvement & People
- Drive RCA and CAPA (Corrective & Preventive Action) discipline for every
- critical defect and client escalation, with verified closure.
- Partner with Training & Development to convert audit insights into
- competency-based learning interventions.
- Lead, mentor and build the quality and compliance organization; define career
- paths, succession and capability plans.
- Span of Control & Scope
Dimension
Team Size (typical)
Processes Covered
Transaction Oversight
Geographic Scope
Budget
Scope
200+ across Quality Analysts, Sr. Analysts, Team Leads,
Compliance Leads and Managers
Full RCM value chain — front, middle and back-end
Quality assurance over large transactions per month
India delivery center(s) supporting multiple US healthcare
clients
Quality & compliance function operating plan and tooling
budget
- Key Stakeholders
Stakeholder
US Client Leadership
Nature of Engagement
QBRs, governance, audit calibration, escalation
management
RCM Operations Leaders
Training & Capability
Embedding quality at source, CAPA execution, SLA
alignment
Targeted training based on audit and compliance findings
Stakeholder
- Regulatory interpretation, breach management, policy
- QA tooling, automation of quality checks, dashboarding
- Workforce planning, capability building, succession
- Competency Framework
Functional / Technical Competencies
Expected Proficiency
Expert — full value-chain knowledge, payer dynamics
Medical Coding
(ICD-10/CPT/HCPCS)
Regulatory Compliance
(HIPAA/CMS/OIG)
Advanced — able to adjudicate coding quality disputes
Expert — sets policy, leads audits
Quality Methodologies
Audit & CAPA Governance
Expert — Six Sigma, Lean, statistical sampling
Expert — designs and runs end-to-end frameworks
Data & Reporting
Competency
Executive Presence
Influence Without Authority
Decision Quality
Accountability & Ownership
Advanced — Excel, scorecard analytics
Behavioral / Leadership Competencies
Behavioral Indicator
Commands credibility in C-suite and client governance
forums
Drives quality culture across operations they don’t own
Makes sound risk-based judgments under ambiguity
Owns outcomes end-to-end; no diffusion of responsibility
Talent Development
Resilience
Builds bench strength and succession depth
Maintains standards under client and operational pressure
Education: Bachelor’s degree
Experience: 12–18 years in US Healthcare RCM, with a minimum of 5 years
leading quality and compliance at scale.
Industry Setting: BPO / GCC / captive environments serving US healthcare
providers.
Kindly Note: At Credence, we uphold the highest standards of integrity in our recruitment process. We do not charge any fees at any stage of the hiring process, and we strictly prohibit any third parties, vendors, or individuals from soliciting money in exchange for job opportunities at Credence.
If you are approached by anyone requesting payment or offering you a position at Credence in exchange for money, do not engage with them. Such actions are fraudulent and not authorized by Credence. Please report any such incidents immediately to our official HR team at [email protected]
Your safety and trust are important to us. Thank you for helping us maintain a fair and transparent hiring environment.
