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Role summary: Strengthen authorization quality and audit readiness by owning audit support, issue tracking, and process improvement for Authorization Management as an Authorization Quality Senior Analyst in Chennai, India (Hybrid). In this role, you'll apply healthcare operations and quality expertise to validate authorization-related work, identify root causes of recurring quality issues, and drive improvements to reporting and operational workflows. You will report to the Senior Operations Manager.
Team summary: The Authorization Management Quality team supports agents and operations colleagues who handle pre-certifications and referral-related work for providers. The team is accountable for quality oversight, audit support, issue resolution, cross-functional coordination, and ongoing process improvement. You will contribute by leveraging operational analysis, quality insights, and athenahealth workflow knowledge to improve service delivery, strengthen accountability, and help scale authorization management operations.
Essential Job Responsibilities
- Conduct authorization quality reviews using established criteria, SOPs, and audit standards.
- Support internal and external audits by preparing accurate evidence, logs, and quality documentation.
- Track quality issues to closure by documenting findings, maintaining issue records, and monitoring remediation progress.
- Analyze recurring authorization quality defects to identify root causes and opportunities for process improvement.
- Validate that corrective actions and operational changes align to quality expectations and measurable outcomes.
- Coordinate with operations and cross-functional partners to resolve authorization quality gaps efficiently.
- Maintain clear, audit-ready reporting and documentation that reflect decisions, outcomes, and supporting notes.
- Recommend process and workflow enhancements to reduce repeat issues and improve authorization handling consistency.
- Use AI-enabled tools to accelerate review and learning (e.g., AI-assisted summarization of case notes and discrepancy highlighting) while applying your judgment to verify accuracy and follow SOPs.
Additional Job Responsibilities
- Participate in quality calibration sessions to align on interpretations, standards, and acceptance criteria.
- Contribute to job aids, training materials, and process updates based on observed trends.
- Assist with creation or refinement of quality metrics and dashboards used by the team.
- Support escalations by providing structured findings and recommended next steps.
- Perform ad hoc quality checks to support operational releases or process changes.
- Provide feedback to operations teams on documentation completeness and audit readiness.
Expected Education & Experience
- Experience in a healthcare environment and/or quality-focused operational role.
- Bachelor's degree required graduation in Nursing, Dentistry, Physiotherapy, or any health/life science preferred.
- 3-5 years of relevant professional experience in the healthcare industry (as applicable to the role's senior analyst quality responsibilities).
- Experience in quality, audit, operations, or related analytical operational roles preferred.
- Comfort applying SOPs and quality/audit criteria to authorization-related work.
- Strong documentation skills with attention to accuracy and traceability.
- Analytical mindset to identify patterns, contribute to root-cause discussions, and support improvement initiatives.
- Ability to work effectively in a hybrid environment based in Chennai, India.
Travel: NA % travel annually.
