RCM AR Quality Team Lead - Hyderabad

ECLAT Health Solutions; Hyderabad; On-site; INR 600,000 - 1,200,000; Full time

Job summary

ECLAT Health Solutions in Hyderabad is seeking a QA Lead for AR quality audits within US Healthcare RCM. You will lead audits for AR calls, denials, appeals, and follow-up, ensuring accuracy, compliance, and process adherence across claims.

The role emphasizes identifying gaps, publishing QA dashboards, and driving improvements with Operations and Training teams, while maintaining HIPAA compliance and escalation management.

Qualifications

• Experience in US healthcare RCM AR/Denials/Appeals.
• Hands-on quality auditing and quality management.
• Knowledge of CPT, ICD-10, HCPCS, modifiers, EOB/ERA.
• Understanding payer guidelines and denial management.
• Strong Excel and QA reporting capabilities.

Responsibilities

• Lead and manage AR Quality Audits for US Healthcare RCM processes.
• Perform quality audits for AR Calling, Denials, Appeals, and Follow-up.
• Review claims for accuracy, compliance, documentation, and process adherence.
• Identify quality gaps, error trends, and process improvement opportunities.
• Prepare and publish QA reports, dashboards, and performance metrics.
• Conduct RCA, feedback sessions, calibration, and quality coaching.
• Work closely with Operations and Training teams to improve GCR/NCR and overall quality performance.
• Ensure adherence to client SOPs, payer guidelines, and HIPAA requirements.
• Handle escalations and support continuous improvement initiatives.

Skills

US RCM AR/Denials

Quality Auditing

CPT ICD-10 HCPCS

Payer Guidelines

MS Excel

QA Reporting Tools

Analytical Skills

Communication

Team Leadership

Job description

Industry: Healthcare RCM / Medical Billing

Job Responsibilities

• Lead and manage AR Quality Audits for US Healthcare RCM processes.
• Perform quality audits for AR Calling, Denials, Appeals, and Follow-up.
• Review claims for accuracy, compliance, documentation, and process adherence.
• Identify quality gaps, error trends, and process improvement opportunities.
• Prepare and publish QA reports, dashboards, and performance metrics.
• Conduct RCA, feedback sessions, calibration, and quality coaching.
• Work closely with Operations and Training teams to improve GCR/NCR and overall quality performance.
• Ensure adherence to client SOPs, payer guidelines, and HIPAA requirements.
• Handle escalations and support continuous improvement initiatives.

Required Skills

• Strong knowledge of US Healthcare RCM – AR / Denials / Appeals.
• Hands-on experience in Quality Auditing / Quality Management.
• Knowledge of CPT, ICD-10, HCPCS, Modifiers, EOB/ERA and medical billing concepts.
• Good understanding of payer guidelines and denial management.
• Strong analytical, communication, reporting, and team-handling skills.
• Proficiency in MS Excel and QA reporting tools.