Quality Analyst

AuraRCM & Consulting Inc.; Chennai District; On-site; INR 500,000 - 750,000; Full time

Job summary

AuraRCM & Consulting Inc. is seeking a quality auditor to conduct scheduled and ad-hoc audits of processed RCM transactions, ensuring adherence to defined quality parameters in a Chennai-based setting.

The role involves monitoring claim submissions, payment posting, denial handling, and eligibility verification for accuracy and compliance. You will lead root cause analyses, provide objective coaching, and contribute to leadership reporting with findings and recommendations to improve processes

Qualifications

• Auditing and Monitoring to verify RCM transactions against quality parameters.
• Compliance verification with HIPAA, client billing rules, and regulations.
• Root cause analysis to identify process gaps, training issues, or errors.
• Feedback and coaching to implement corrective actions for associates.
• Reporting of quality metrics, trends, and audit findings to leadership.
• Standardization through updated process docs, checklists, and SOPs.
• Calibration to ensure consistent understanding of standards across teams.
• Target achievement to meet quality and accuracy benchmarks.

Job description

• Auditing & Monitoring: Conduct scheduled and ad-hoc audits of processed RCM transactions (including claim submissions, payment posting, denial handling, and eligibility verification) against defined quality parameters.
• Compliance Verification: Ensure strict adherence to HIPAA guidelines, client-specific billing rules, and regulatory requirements in all audited samples.
• Root Cause Analysis (RCA): Investigate identified errors and deviations to determine the root cause, distinguishing between process gaps, training issues, or individual errors.
• Feedback & Coaching: Provide constructive, objective feedback and collaborate with Team Leaders and Process Trainers to implement effective coaching and corrective action plans for associates.
• Reporting: Compile, analyze, and present detailed quality reports, performance trends, and audit findings to leadership, highlighting areas of risk and recommending improvements.
• Standardization: Assist in the creation and maintenance of updated process documentation, quality checklists, and standard operating procedures (SOPs).
• Calibration: Participate in quality calibration sessions to ensure consistent understanding and application of quality standards across all teams.
• Target Achievement: Ensure the entire process consistently meets the required quality and accuracy benchmarks set by both Aura BPO and the client.