Senior Director

Credence Global Solutions; Pune District; On-site; INR 1,200,000 - 2,000,000; Full time

Job summary

Credence Global Solutions seeks a Senior Director / AVP – Quality & Compliance to lead the QA ecosystem and regulatory posture for India-based RCM operations. You will own audit governance, drive a zero-defect culture and serve as bridge to US client quality counterparts.

Role requires strategic, client-facing leadership across compliance, audits and continuous improvement with a focus on scalable processes and governance across the entire RCM value chain.

Qualifications

• Bachelor's degree in a relevant field.
• 12–18 years in US Healthcare RCM with a minimum of 5 years leading quality and compliance at scale.
• Experience with audits, CAPA and client governance.

Responsibilities

• Own end-to-end Quality Management System across RCM sub-processes.
• Lead regulatory compliance including HIPAA, CMS, OIG, NCCI and state regs.
• Present quality metrics in QBRs to US client leadership with trends and action plans.
• Drive RCA/CAPA and training alignment to improve quality outcomes.

Skills

Quality management

Regulatory compliance

Leadership

Risk management

Stakeholder management

Data analysis

Education

Bachelor's degree

Job description

Quality Assurance

Roles & Responsibilities

1. Role Purpose

   The Senior Director / AVP – Quality & Compliance is the single accountable leader for the quality assurance ecosystem and regulatory compliance posture across all Revenue Cycle Management operations delivered from the India center. The role exists to guarantee that every transaction — from patient access and coding through billing, A/R follow-up, payment posting and denial management — meets the accuracy, integrity and regulatory standards expected by US healthcare clients and mandated by HIPAA, CMS and payer requirements. This is a strategic and client-facing role. The incumbent owns the quality narrative in client governance forums, drives a measurable zero-defect culture, and serves as the bridge between India operations and US client quality and compliance counterparts.

2. Principal Accountabilities
   • Quality Management System (QMS): Own, design and continuously evolve the end-to-end Quality Management System across all RCM sub-processes — eligibility & benefits, charge capture, medical coding, claims submission, A/R follow-up, denials & appeals, payment posting and credit balances. Define audit methodologies, sampling models, scoring rubrics, error taxonomies and weightages aligned to client and regulatory expectations. Establish multi-layered audit governance: transactional audits, process audits, compliance audits and pre-bill/pre-payment quality gates.
3. Regulatory Compliance
   • Own the compliance framework aligned to HIPAA Privacy & Security Rules, CMS billing guidelines, OIG Work Plan, NCCI edits, payer-specific policies and applicable state regulations.
   • Maintain the compliance risk register; conduct periodic risk assessments and lead remediation of identified gaps.
   • Lead readiness for client audits, SOC/ISO/HITRUST assessments and external regulatory reviews.
4. Governance & Client Engagement
   • Own the Quality Scorecard and present monthly reviews and Quarterly Business Reviews (QBRs) to US client leadership with trends, RCA findings and corrective action plans.
   • Run calibration sessions with US client quality counterparts to keep audit alignment and reduce scoring variance to under 5%.
   • Act as escalation owner for all quality‑and compliance‑related client concerns.
5. Continuous Improvement & People
   • Drive RCA and CAPA (Corrective & Preventive Action) discipline for every critical defect and client escalation, with verified closure.
   • Partner with Training & Development to convert audit insights into competency‑based learning interventions.
   • Lead, mentor and build the quality and compliance organization; define career paths, succession and capability plans.
6. Span of Control & Scope
   • Team Size (typical): 200+ across Quality Analysts, Sr. Analysts, Team Leads, Compliance Leads and Managers
   • Processes Covered: Full RCM value chain — front, middle and back‑end
   • Transaction Oversight: Quality assurance over large transactions per month
   • Geographic Scope: India delivery center(s) supporting multiple US healthcare clients
   • Budget: Quality & compliance function operating plan and tooling budget
7. Key Stakeholders
   • US Client Leadership – QBRs, governance, audit calibration, escalation management
   • RCM Operations Leaders – Training & Capability; embedding quality at source, CAPA execution, SLA alignment; targeted training based on audit and compliance findings
   • Compliance & Legal – regulatory interpretation, breach management, policy updates
   • Technology / Automation – QA tooling, automation of quality checks, dashboarding
   • HR – Competency; US Healthcare RCM Domain; Workforce planning, capability building, succession
8. Competency Framework
   • Functional / Technical Competencies
     • Expert: full value-chain knowledge, payer dynamics; Medical Coding (ICD‑10/CPT/HCPCS); Regulatory Compliance (HIPAA/CMS/OIG); Quality Methodologies; Audit & CAPA Governance; Data & Reporting; Executive Presence; Influence Without Authority; Decision Quality; Accountability & Ownership; Advanced: Excel, scorecard analytics
     • Advanced: able to adjudicate coding quality disputes; Expert: sets policy, leads audits; Expert: designs and runs end-to-end frameworks; Advanced: Excel, scorecard analytics
   • Behavioral / Leadership Competencies
     • Commands credibility in C‑suite and client governance forums
     • Drives quality culture across operations they don't own
     • Makes sound risk‑based judgments under ambiguity
     • Owns outcomes end‑to‑end; no diffusion of responsibility
     • Talent Development, Resilience, Builds bench strength and succession depth
     • Maintains standards under client and operational pressure

Candidate Requirements

Education: Bachelor's degree

Experience: 12–18 years in US Healthcare RCM, with a minimum of 5 years leading quality and compliance at scale.

Industry Setting: BPO / GCC / captive environments serving US healthcare providers.