Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.
Role summary: Drive measurable improvements in revenue cycle quality by leading end-to-end quality assurance, denial analysis, and process improvement initiatives. As a Senior Operations Analyst (Quality), you will leverage RCM expertise to identify root causes, reduce rework, and enhance accuracy across AR and denials workflows. You will use data, audits, and statistical insights to strengthen process adherence and drive consistent, high-quality outcomes.
Team summary: The Quality team is responsible for ensuring accuracy, consistency, and continuous improvement. The team partners with Operations, Product Lines, and BPO's to:
- Identify quality gaps
- Drive process standardization
- Enable scalable, high-quality execution across BPO and internal teams
Essential Job Responsibilities:
- Conduct end-to-end quality audits on AR calling and denial workflows to ensure adherence to SOPs and quality standards
- Analyze denial trends and quality defects to identify root causes (user, process, system)
- Drive corrective and preventive actions (CAPA) to reduce recurring errors and rework
- Establish and monitor quality metrics (accuracy, defect rate, rework, first-pass yield)
- Partner with Operations and BPO teams to improve process adherence and performance outcomes
- Perform deep-dive analyses on escalations and high-impact quality issues
- Ensure audit documentation, traceability, and compliance with quality standards
- Lead quality calibrations to align on defect definitions, scoring, and expectations
- Support workflow and SOP improvements based on audit insights and field feedback
- Leverage data and AI-enabled tools (where applicable) to improve audit efficiency and insight generation
Additional Job Responsibilities
- Coach and guide teams on quality expectations, error prevention, and best practices
- Contribute to training content, job aids, and knowledge management
- Participate in governance reviews with stakeholders to present quality trends and actions
- Support process improvement initiatives focused on reducing cycle time and improving accuracy
- Collaborate with Product/Service teams to close gaps in workflows and documentation
Expected Education & Experience
- 4-6 years of experience in Healthcare RCM operations, quality, or a related analytical operational role.
- Strong experience in denial management and AR workflows - including reviewing denial reasons and driving appropriate next steps.
- Proven ability in root cause analysis and driving process improvements
- Solid understanding of RCM lifecycle (claims, denials, rework drivers, resolution paths)
- Experience with quality frameworks, audit methodologies, and SOP adherence
- Strong analytical skills with ability to translate insights into actionable improvements
- Effective stakeholder management and communication skills
- Familiarity with athenaNet or similar RCM platforms is a plus
