Quality Assurance Manager

Job Description

Our client is seeking an experienced Quality Assurance Manager to lead and strengthen the Quality Assurance function across US Healthcare Revenue Cycle Management (RCM) operations.

Key Responsibilities

• Lead and oversee the QA function across multiple RCM processes, aligned with business objectives, quality standards and client SLAs.
• Develop and continuously improve QA frameworks, audit methodologies and governance processes.
• Identify process gaps, conduct root cause analyses, and implement corrective and preventive actions.
• Leverage automation and Al to enhance QA processes, accuracy and operational efficiency. 
• Monitor quality dashboards, reports and analytics, providing actionable insights to leadership.
• Ensure adherence to HIPAA, CMS guidelines, payer requirements and internal quality standards.
• Lead, coach and develop the QA team.
• Partner with Operations, Technology, Compliance and Analytics teams to improve quality outcomes.
• Present quality metrics, trends and improvement initiatives in client governance meetings.

Qualifications & Experience

• Bachelor's degree in Healthcare Management, Business Administration or a related discipline.
• 7+ years of US Healthcare RCM experience, including 4+ years in Quality Assurance and 3+ years in people leadership.
• Strong knowledge of Medical Billing, AR Management, Denial Management, Payment Posting and Medical Coding.
• In-depth understanding of HIPAA, CMS guidelines and payer compliance requirements.
• Experience in continuous improvement, process optimization and root cause analysis; Lean or Six Sigma exposure preferred.
• Exposure to automation, Al-enabled solutions or digital transformation is highly desirable.
• Proficiency in Advanced Excel, Power BI or Tableau.
• CPC, CCS, CRCP, Lean Six Sigma or related certifications are an advantage.
  Strong leadership, communication, analytical and stakeholder management skills.