QA/ Process Specialist - RCM

Overview

Lead QA and process work for Huron's Revenue Cycle Management (RCM) operations, covering team handling, audits, work allocation, client interaction and RCM metrics reporting to leadership.

What you'll do

• Handle a team and allocate work across RCM processes.
• Perform quality checks and audits on all claims processed, per the quality policy or client SOP.
• Ensure claims are processed in compliance with billing rules and that errors are identified in QA and actions initiated before claims are rebilled to insurance.
• Implement Lean Six Sigma methodologies to improve process accuracy.
• Review audit parameters regularly and modify them as required.
• Prepare daily, weekly and monthly audit metrics reports and share them with leadership.
• Analyze findings and present clear, concise, actionable summaries to leadership.
• Build strong relationships with Team Leaders and Managers by demonstrating gaps, trends and patterns identified in data and reports.
• Suggest improvements and set up calibration sessions with onshore and internal teams.
• Document quality-related MIS work to keep operations running smoothly and systems easy to maintain.

What you'll need

• Graduate in any discipline.
• 3+ years of industry experience.
• 2+ years of experience in relevant RCM functions performing quality audits.
• Thorough understanding of RCM processes such as Billing, Cash Posting, Credit Balance, Accounts Receivables, Denial Management and Correspondence review.
• Very good understanding of RCM metrics such as Days in AR, Ageing above 90 days, Collections and bad debt.
• Hands-on reporting experience with proficiency in MS Excel and MS PowerPoint.
• Strong ability to analyze raw data, draw conclusions and develop actionable recommendations.
• Ability to handle multiple reporting tasks simultaneously.
• Ability to adapt quickly to new and changing technical environments, with strong analytical, problem-solving and quantitative abilities.
• Solid verbal and written communication skills.

Nice to have

• Quality-related certifications such as Lean Six Sigma.

Details

• Location: Chennai, 6th Floor.
• Position level: Associate.
• Country: India.