Manager Quality

MedExpert Billing; Chennai District; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

MedExpert Billing is seeking a Quality Manager for its Chennai office to oversee and enhance quality assurance processes across Revenue Cycle Management (RCM). This position demands a leader with 12–15 years of experience in RCM, specializing in quality control and compliance.

Your role will involve developing quality frameworks, conducting audits, and improving processes to ensure compliance with industry standards like HIPAA. Ideal candidates should possess strong analytical skills and communication abilities.

Qualifications

• 12–15 years of experience in RCM with at least 3+ years in a quality leadership role.
• Strong knowledge of end-to-end RCM processes.
• Expertise in medical coding, billing, and denial management.

Responsibilities

• Develop and implement quality assurance frameworks across RCM processes.
• Conduct regular audits of coding, billing, and AR processes.
• Lead and mentor QA analysts and auditors.
• Prepare and present quality dashboards to leadership and clients.
• Ensure compliance with healthcare regulations.

Skills

Quality Assurance

Auditing

Medical Coding

Denial Management

Leadership

Communication

Analytical Skills

Education

Any Graduate

Job description

Job Title: Quality Manager – Revenue Cycle Management (RCM)

Job Summary

The Quality Manager is responsible for overseeing and enhancing quality assurance processes across all RCM functions, billing, AR follow-up, and denial management. This role ensures compliance with client requirements, regulatory standards, and internal benchmarks while driving continuous improvement and operational excellence.

Key Responsibilities

1. Quality Assurance & Auditing

• 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
• 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)
• 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

Required Qualifications

• Any graduate
• 12–15 years of experience in RCM with at least 3+ years in a quality leadership role
• 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