RESPONSIBILITIES
- Lead and drive overall quality strategy across end-to-end RCM functions
- Define and implement quality frameworks, SOPs, and audit mechanisms aligned with client and regulatory standards
- Ensure compliance with CMS, HIPAA, provider guidelines, and industry regulations
- Establish strong governance models, KPIs, and quality scorecards for performance tracking
- Drive continuous quality improvement initiatives using RCA, Six Sigma, and Lean methodologies
- Identify trends in denials, errors, and audit failures and implement corrective actions
- Manage internal & external audits, ensuring audit readiness and compliance adherence
- Partner with operations teams to reduce rework, improve accuracy, and enhance first-pass yield
- Lead client quality reviews (QBRs) and act as the point of contact for quality-related escalations
- Ensure client SLA adherence, service excellence, and long-term retention
- Build and manage high-performing QA teams, including hiring, training, and capability development
- Drive a culture of quality ownership, accountability, and continuous improvement
- Leverage automation, analytics, and AI tools to improve quality monitoring and predictive insights
- Work closely with leadership on strategic initiatives, process transformation, and cost optimization
COMPETENCIES, SKILLS, AND OTHER REQUISITES
- Service Delivery Leadership
- Strategic Thought leadership to grow business.
- External and Internal Stakeholder Management
- Problem Solving and Analytical Skills
- Unflinching integrity and personal work ethics
- Self-starter who strives for self and team excellence
- Attention to detail and concern for accuracy.
- Excellent time management skills and multi-tasking ability
- Excellent written and spoken English.
PROFESSIONAL BACKGROUND
- Minimum 15 years of experience in US Healthcare (RCM - AR Operations/End to End RCM ) Experience is must.
- Must have experience in Quality
