QA/ Process Specialist - RCM

Huron Consulting; Bengaluru; On-site; INR 600,000 - 900,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

401(k) plan

Employee stock purchase plan

Paid time off

Parental leave

Job summary

Huron Consulting is seeking a skilled RCM QA/Process Specialist to lead QA audits, allocate work, and interact with clients while generating RCM metrics reports for leadership. The role requires attention to detail, strong analytical ability, and proficiency in MS Excel and MS PowerPoint.

You will handle claims quality checks, ensure compliance with billing rules, and drive continuous improvement through data-driven insights and coordination with onshore teams.

Qualifications

• 3+ years of industry experience.
• 2+ years experience in RCM-related quality audits.
• Hands-on reporting experience with MS Excel and MS PowerPoint.
• Strong ability to analyze raw data and develop actionable recommendations.
• Ability to manage multiple reporting tasks simultaneously.
• Excellent verbal and written communication skills.

Responsibilities

• Perform quality checks/audits on claims processed per quality policy or client SOP.
• Generate and distribute RCM metrics reports to leadership.
• Ensure claims are processed in compliance with billing rules; identify errors before rebill.
• Prepare daily, weekly and monthly audit metrics for leadership review.
• Liaise with Team Leaders/Managers to identify gaps and improvement opportunities.

Skills

Analytical thinking

Data interpretation

Multitasking

Strong communication

Quality focus

Education

Graduate

Lean Six Sigma (certification)

Tools

MS Excel

MS PowerPoint

Job description

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.

Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.

Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.

Join our team as the expert you are now and create your future.

Job Description Summary

As an RCM QA/ Process Specialist, you will be responsible for team handling, audits, work allocation, client interactions and generate distribute RCM metrics reports to the leadership team.

Excellent communication skills, attention to detail, and strong technical and problem-solving skills are essential aspects of this role.

Job Description

• Thorough understanding of RCM processes like Billing, Cash Posting, Credit Balance, Accounts Receivables, Denial Management & Correspondence review
• Very good understanding of RCM metrics like Days in AR, Ageing above 90 days, Collections and bad debt
• Perform Quality checks/audits on all claims processed as per quality policy or as per client SOP
• Responsible for getting the claims processed in compliance to the billing rules mentioned and ensure all errors are identified in QA and actions initiated before the claim is rebilled to the insurance
• Implement Lean Six sigma mythologies to improve the accuracy of the processes
• Consistently review the audit parameters and modify as per the necessary requirement
• Prepare daily, weekly & monthly audit metrics reports and share it with leadership
• Conduct analysis and present summary of findings to leadership in a clear, concise, convincing and actionable format
• Establish a strong relationship with Team Leaders / Managers by demonstrating the gaps, trends & patterns identified during the data/report compilation
• Suggest ways of improvements and set up calibration sessions with onshore and internal teams
• Develops documentation of quality related MIS work to have smooth operations and easy system maintenance

QUALIFICATIONS

• 3+ years of industry experience
• 2+ year Experience in relevant RCM functions performing quality audits
• Hands on experience in reporting with proficiency in MS Excel and MS PowerPoint
• Strong ability to analyze raw data, draw conclusions and develop actionable recommendations
• Ability to handle multiple tasks of reporting simultaneously
• Ability to adapt quickly to new and changing technical environments as well as strong analytical, problem solving and quantitative abilities.
• Solid verbal and written communication skills are required.

Education/Certifications

• Graduate
• Any quality related certifications like Lean Six Sigma can be an added advantage

Education/Certifications

• Graduate in any discipline.

ABOUT HURON

At Huron, we're redefining what a consulting organization can be. We go beyond advice to deliver results that last. We inherit our client's challenges as if they were our own. We help them transform for the future. We advocate. We make a difference. And we intelligently, passionately, relentlessly do great work…together.

Are you the kind of person who stands ready to jump in, roll up your sleeves and transform ideas into action? Then come discover Huron.

Whether you have years of experience or come right out of college, we invite you to explore our many opportunities. Find out how you can use your talents and develop your skills to make an impact immediately. Learn about how our culture and values provide you with the kind of environment that invites new ideas and innovation. Come see how we collaborate with each other in a culture of learning, coaching, diversity and inclusion. And hear about our unwavering commitment to make a difference in partnership with our clients, shareholders, communities and colleagues.

Huron Consulting Group offers a competitive compensation and benefits package including medical, dental, and vision coverage to employees and dependents; a 401(k) plan with a generous employer match; an employee stock purchase plan; a generous Paid Time Off policy; and paid parental lea