Quality Manager - Revenue Cycle Management (RCM) - Chennai

Location: Chennai   •   Experience: Senior Level   •   Openings: 1
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Job description

Title : Quality Manager - Revenue Cycle Management (RCM) – Chennai
Shift: 6.30pm to 3.30am
Key Responsibilities
  • 10–12 years of experience in RCM with at least 3+ years in a quality leadership role
  • Develop and implement quality assurance frameworks across RCM processes
  • Conduct regular audits of coding, billing, and AR processes
  • Ensure adherence to payer guidelines, client SOPs, and regulatory standards (HIPAA, CMS, etc.)
  • Monitor accuracy, productivity, and compliance metrics
2. Process Improvement
  • Identify quality gaps and root causes of errors
  • Drive continuous improvement initiatives (Lean, Six Sigma, etc.)
  • Collaborate with operations teams to reduce denials and improve first-pass yield
  • Standardize best practices across teams
3. Team Management
  • Lead and mentor QA analysts and auditors
  • Set performance goals and KPIs for the quality team
  • Conduct regular training and calibration sessions
  • Ensure consistency in audit scoring and feedback
4. Reporting & Analytics
  • Prepare and present quality dashboards and reports to leadership and clients
  • Track KPIs such as accuracy rates, denial rates, turnaround time, and rework
  • Provide actionable insights to improve operational performance
5. Compliance & Risk Management
  • Ensure compliance with healthcare regulations (HIPAA, ICD-10, CPT, HCPCS)
  • Conduct internal compliance audits
  • Support external audits and client reviews
  • Mitigate risks related to billing errors and revenue leakage
6. Client Interaction
  • Act as a quality SPOC for clients
  • Participate in client calls and business reviews
  • Address client escalations related to quality issues
  • Align quality goals with client expectations
Key Skills & Competencies
  • Strong knowledge of end-to-end RCM processes
  • Expertise in medical coding, billing, and denial management
  • Analytical and problem-solving skills
  • Leadership and stakeholder management
  • Excellent communication and presentation skills Familiarity with quality tools and methodologies