Job Family:
EBO Quality (India)
Travel Required:
None
Clearance Required:
None
What You Will Do
-
Conduct quality audits on inpatient and observation accounts requiring Notification on Admission (NOA), in line with sampling guidelines.
-
Validate accurate submission of notifications through portals, EDI, fax, or calls, and ensure timely initiation of non-clinical authorizations.
-
Review documentation accuracy, including reference numbers, authorization numbers, payer timelines, and compliance requirements.
-
Perform root cause analysis on identified defects, develop CAPA plans, and track recurring trends such as missed NOAs, delays, and documentation gaps.
-
Provide actionable feedback on audit findings, support process clarifications, lead performance improvement discussions, and participate in periodic team reviews.
-
Prepare daily, weekly, and monthly quality reports, track SLA and accuracy metrics, and contribute to governance reviews.
-
Participate in calibration sessions, refresher initiatives, and training programs to strengthen process quality.
What You Will Need
-
Strong knowledge of US Healthcare Revenue Cycle Management (RCM).
-
Strong understanding of Authorization and Notification on Admission (NOA) workflows, backed by relevant hands-on experience.
-
At least 3 years of experience in US Healthcare RCM.
-
Strong analytical, problem-solving, and attention-to-detail skills.
-
Good communication skills with the ability to provide clear, constructive feedback.
-
Prior experience in a QA or Auditor role.
-
Willingness to work on Night Shifts.
-
Any UG Degree - Mandatory (Diploma not eligible)
What Would Be Nice To Have
-
Prior experience in Quality Audits / Quality Assurance within US Healthcare RCM
-
Exposure to multiple RCM functions (AR, Denials, Charge Entry, Payment Posting)
-
Experience in trend analysis, data interpretation, and quality reporting
-
Familiarity with audit tools, scorecards, and quality metrics
-
Knowledge of HIPAA compliance and quality standards
-
Ability to mentor team members and support performance improvement initiatives
What We Offer:
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
About Guidehouse
Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
