About the Role:
We are seeking a sharp, detail-oriented Quality Analyst with proven experience in U.S. Healthcare Revenue Cycle Management (RCM) to join our growing team. This role is critical in ensuring accuracy, compliance, and process excellence across the entire RCM lifecycle—from End-to-End. If you have a passion for quality, a strong understanding of billing workflows, and a keen eye for detail, we'd love to hear from you.
Key Responsibilities:
- Conduct quality audits for RCM functions, including Eligibility, Authorization, Charge Entry, Claims Submission, Payment Posting, Denial Management, and AR Follow-up
- Analyze test requirements and perform functional, regression, and end-to-end testing on healthcare billing applications
- Validate HIPAA-compliant claim files, payer rules, CPT/ICD code mapping, and insurance-specific workflows
- Perform backend data validation using SQL to ensure data integrity across billing and financial records
- Identify errors, audit trends, and training needs to improve team performance and billing accuracy
- Generating comprehensive reports on quality performance and sharing feedback with team members on a weekly or monthly basis.
- Collaborate with cross-functional teams, including operations, training, developers, and business analysts, to support process enhancements
- Track and report key quality metrics, driving continuous improvement initiatives
- Ensure compliance with HIPAA, CMS, and U.S. healthcare payer regulations
- Support UAT and production validations for new releases and billing system updates
- Lean Six Sigma (Green Belt / Black Belt): For reducing errors, improving workflows, and driving operational efficiency.
- Certified Quality Auditor (CQA) – ASQ: For professionals conducting audits of quality systems and processes.
- Project Management Professional (PMP): For managing cross-functional QA and system improvement projects.
- Certified Health Data Analyst (CHDA) – AHIMA: For analyzing healthcare data to improve billing and QA outcomes.
- SQL/Data Analytics Certifications (Microsoft, Oracle, Coursera): For backend validation and reporting.
Required Qualifications:
- 1–5 years of hands-on QA or auditing experience in U.S. Healthcare RCM and medical billing
- In-depth knowledge of end-to-end RCM workflows: Eligibility, Authorization, Coding, Claims, Denials, and AR
- Solid understanding of HIPAA and healthcare data privacy standards
- Excellent attention to detail, communication, and analytical skills
- Experience with billing or practice management platforms (e.g., Kareo, AdvancedMD, eClinicalWorks, Athena, Epic, or Cerner) and also in payor portals
Why Join Us:
- Opportunity to work with a dynamic team of professionals and achieve growth and expertise in your chosen field.
- Competitive salary, bonuses, and comprehensive benefits package.
- Ready to take your design and development game to the next level Join us!
