QA/ Process Specialist - RCM

Overview

As an RCM QA/Process Specialist, you will handle teams, perform audits, allocate work, interact with clients, and generate and distribute RCM metrics reports to leadership.

What you'll do

• Perform quality checks and audits on all claims processed according to the quality policy or client SOP.
• Ensure claims are processed in compliance with billing rules and identify errors in QA before claims are rebilled to insurance.
• Implement Lean Six Sigma methodologies to improve process accuracy.
• Review audit parameters consistently and modify them as necessary.
• Prepare daily, weekly, and monthly audit metrics reports and share them with leadership.
• Analyze findings and present summaries to leadership in a clear, concise, convincing, and actionable format.
• Establish relationships with Team Leaders and Managers by demonstrating gaps, trends, and patterns identified during data and report compilation.
• Suggest improvements and set up calibration sessions with onshore and internal teams.
• Develop documentation of quality-related MIS work to support smooth operations and easy system maintenance.
• Handle teams, allocate work, interact with clients, and generate and distribute RCM metrics reports to the leadership team.

What you'll need

• 3+ years of industry experience.
• 2+ years of experience in relevant RCM functions performing quality audits.
• Graduate in any discipline.
• 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 experience in reporting 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.
• Strong analytical, problem-solving, and quantitative abilities.
• Solid verbal and written communication skills.

Nice to have

• Quality-related certifications such as Lean Six Sigma can be an added advantage.

Details

• Location: Bangalore, India.
• Position level: Associate.