Job Title: Assistant Manager –Quality (RCM)
Job Summary
The Quality Assistant Manager is responsible for overseeing and enhancing quality assurance processes across all RCM functions, billing, AR follow-up, and denial management. This role ensures compliance with client requirements, regulatory standards, and internal benchmarks while driving continuous improvement and operational excellence
Key Responsibilities
1. Quality Assurance s Auditing
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Develop and implement quality assurance frameworks across RCM processes
- Conduct regular audits of coding, billing, and AR processes • Ensure adherence to payer guidelines, client SOPs, and regulatory standards (HIPAA, CMS, etc.)
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Monitor accuracy, productivity, and compliance metrics
2. Process Improvement
- Identify quality gaps and root causes of errors
- Drive continuous improvement initiatives (Lean, Six Sigma, etc.)
- Collaborate with operations teams to reduce denials and improve first-pass yield
- Standardize best practices across teams
3. Team Management
- Lead and mentor QA analysts and auditors
- Set performance goals and KPIs for the quality team •
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Conduct regular training and calibration sessions
- Ensure consistency in audit scoring and feedback
4. Reporting s Analytics
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Prepare and present quality dashboards and reports to leadership and clients
- Track KPIs such as accuracy rates, denial rates, turnaround time, and rework
- Provide actionable insights to improve operational performance
5. Compliance s Risk Management
- Ensure compliance with healthcare regulations (HIPAA, ICD-10, CPT, HCPCS)
- Conduct internal compliance audits
- Support external audits and client reviews
- Mitigate risks related to billing errors and revenue leakage
6. Client Interaction
- Act as a quality SPOC for clients
- Participate in client calls and business reviews
- Address client escalations related to quality issues
Align quality goals with client expectations
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Required Qualifications
- Any graduate
8–12 years of experience in RCM with at least 3+ years in a quality leadership role
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Key Skills s Competencies
- Strong knowledge of end-to-end RCM processes
- Expertise in medical coding, billing, and denial management
- Analytical and problem-solving skills
- Leadership and stakeholder management
- Excellent communication and presentation skills
- Familiarity with quality tools and methodologies
