RCM AR Quality Team Lead - Hyderabad

ECLAT Health Solutions; Hyderabad; On-site; INR 600,000 - 900,000; Full time

Job summary

ECLAT Health Solutions in Hyderabad is seeking a Senior QA professional to lead AR quality audits for US Healthcare RCM processes, focusing on accuracy, compliance, and denials management.

You will review CPT/ ICD-10 concepts, prepare QA dashboards, drive RCA and coaching, and collaborate with Operations and Training to elevate quality and adherence to HIPAA and client SOPs. Strong analytical and Excel skills are essential for success.

Qualifications

• 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.

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

AR Quality Audits

Quality Auditing

Quality Management

CPT ICD-10 knowledge

Denials management

Payer guidelines

Analytical skills

Communication skills

Tools

MS Excel

QA reporting tools

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.