Quality Analyst

Overview

Quality Analyst role in the EBO Quality team at Guidehouse India, auditing US Healthcare Revenue Cycle Management authorization and Notification on Admission (NOA) workflows.

What you'll 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'll 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).

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.

Details

• Location: Chennai, India.
• Travel required: None.
• Clearance required: None.
• Night shift work is required.