Assistant Vice President - Quality

Job Description

• Quality Strategy & Governance

  . Define and execute the quality strategy for US healthcare RCM operations

  . Establish quality frameworks, SOPs, control mechanisms, and governance models

  . Align quality goals with business objectives, client SLAs, and regulatory standards

• RCM Process Quality Oversight

  . Oversee quality across end-to-end RCM functions:

  o Patient Access & Registration

  o Charge Capture & Coding (ICD-10-CM, CPT, HCPCS)

  o Billing & Claims Submission

  o Payment Posting & Reconciliation

  o Denials Management & AR Follow-ups

  o Credit Balance & Refunds

  . Ensure accuracy, timeliness, and compliance at each stage of the revenue cycle

• Compliance & Regulatory Management

  . Ensure adherence to HIPAA, CMS, Medicare, Medicaid, and payer-specific guidelines

  . Lead internal and external audits (coding, billing, compliance, client audits)

  . Oversee corrective and preventive action plans (CAPA) and risk mitigation

• Audit, Controls & Risk Management

  . Design and monitor audit frameworks (transactional, coding, compliance, client audits)

  . Track error trends, root causes, and systemic issues

  . Implement strong quality controls to reduce revenue leakage and compliance risk

• Client & Stakeholder Management

  . Act as the quality SPOC for US clients and internal leadership

  . Present quality performance, audit findings, and improvement plans to clients

  . Support client onboarding, transitions, and expansions from a quality standpoint

• Metrics, Analytics & Reporting

  . Define and track KPIs such as accuracy, TAT, first-pass yield, denial rates, and rework

  . Leverage data analytics to identify improvement opportunities and predict risks

  . Drive automation, standardization, and best practices using data insights

• Process Excellence & Continuous Improvement

  . Lead Lean, Six Sigma, and process improvement initiatives across RCM workflows

  . Partner with operations, training, and technology teams to improve outcomes

  . Support RPA, AI, and workflow automation initiatives to enhance quality

• Team Leadership & Capability Building

  . Lead, mentor, and develop quality, audit, and compliance teams

  . Build strong coding quality, audit, and regulatory expertise
  Promote a culture of quality, accountability, and continuous improvement

Job Requirements

• Strong expertise in US Healthcare RCM processes and workflows

• Deep knowledge of medical coding, billing, and payer rules

• Experience with HIPAA, CMS, OIG compliance, and audit standards

• Excellent analytical, problem-solving, and stakeholder management skills

• Strong client-facing communication and executive presentation abilities

Qualifications & Experience

• Any Graduate - Preferred Bachelor's degree Business, Quality Management, or related field

• Certifications preferred: CPMA, Six Sigma Black Belt, Lean

• 18+ years of experience in US healthcare RCM quality, audit, or compliance

• Prior leadership experience in healthcare BPO, captive, or provider RCM