Quality Assurance RCM
Job Roles
The below job profile details are to demonstrate eligibility for the position and are not limited to the list below. Strong managerial exposure and thought process is expected for the position to lead team of auditors and supervisors.
- Exposure to QPEX & OPEX activities in HealthCare RCM to improve business efficiency and quality
- Manage entire RCM Quality portfolio including Coding
- Create pipeline for future by cross skilling and upskilling teams
- Exceptional in People management
- BB Six Sigma & Lean trained or certified
- Project Management Skills to establish new quality framework in existing and new business
- Attrition management for entire RCM Quality vertical
- Strong exposure in leading the end to end RCM Business Quality team covering multiple clients, specialties, scopes and functions including but not limited to Coding, Charge Entry, Payment Posting, Billing, Auth, EVBV, AR, etc.
- Ensure all deliverables related to process, people and technology are completed timely
- Perform VSM activities to make process lean
- Exposure to change management implementation
- Build business maps covering process and activities at WBS level to make business uniform across
- Build strong reporting structure for leadership visibility and present the same to internal and external groups
- Automating quality function to the extent possible utilizing latest technology covering Macros, Python, SQL, etc
- Ensuring quality teams coverage on client and internal calls
- Conducting weekly, monthly, quarterly & adhoc reviews with Ops, Internal Quality teams & Clients
- Reviewing customer feedback and understanding customer demands and expectations of products and services and provide timely feedback to quality team and respond back with proposed solution and ensure the same is driven Ensure process SOP’s and other critical documents are up to date
- Ensure errors captured in audits are reported to Operations team along with
- proposed solution and track the implementation of the same
- Timely follow-up on all activities as defined and decided in review and meetings
- Implementation of practices designed to meet organization goal and
- Schedule and drive process change initiatives
- Explore ideas within the organization and implement best practices across teams
- Strong exposure to Report Level Audits and establish the same in the DNA of the organization
- Timely reporting of compliance related errors to the compliance department
- and follow-up on the same to bring them to closure
- Handle escalated rebuttals to bring them to closure
- Conduct Gauge R&R exercise in various forms to reduce knowledge variation in the teams
- Perform brain storming activities to explore improvement opportunities and drive the same
Candidate Requirements
- Minimum 1 year of experience in the role and 1 promotion within the organization
- Client engagement skills to drive conversations
- Creating dashboards and presentations for internal and external reviews
- New business and ramp-up experience
- Quality baselining and staffing experience
- Define target and goals for the team
- Perform R&R activities
- Conduct and make performance review files for all the assigned teams
- Govern maker and checker process for all revenue related activities
- Build governance for smooth function of quality department and ensure
- productivity, accuracy, quality output is delivered
- Make key decisions on quality aspects for better outcomes