Internal Process, Quality & TAT Auditor – Healthcare Operations

eData Services US, L.L.C.; Taguig; Presencial; PHP 420.000 - 680.000; Jornada completa

Descripción de la vacante

eData Services US, L.L.C. is seeking an Internal Process, Quality, and TAT Auditor to join our Operational Excellence team in the Philippines.

You will safeguard healthcare accounts by ensuring SLA compliance, HIPAA privacy, and high-quality work, while digging into root causes to remove bottlenecks and optimize workflows. You will partner with floor leadership to drive improvements across Utilization Review, RCM, and scheduling, using data to push continuous performance gains in a fast-paced

Formación

• 3–5 years of experience in Healthcare BPO/KPO, with 1–2 years in QA/audit.
• Specialized domain knowledge in workers' compensation and med-legal services.
• Strong understanding of US healthcare frameworks, payer/provider dynamics, and HIPAA data privacy.

Responsabilidades

• Audit and validate daily healthcare workflows (Utilization Review, RCM, scheduling).
• Monitor end-to-end lifecycle times and aging reports to prevent SLA breaches.
• Lead Root Cause Analysis and collaborate with Operations Supervisors to implement CAPA plans.
• Proactively recommend workflow changes, resource realignment, or automation opportunities.
• Conduct calibration sessions with Production Leadership to ensure alignment on quality standards.
• Build and maintain daily/weekly dashboards detailing error trends, SLA performance, and compliance metrics.

Conocimientos

Quality Assurance

Root Cause Analysis

Data analysis

SLA compliance

Process improvement

Auditing

Educación

Bachelor's Degree

Healthcare Admin or Finance (preferred)

Herramientas

Excel/Google Sheets

IMS

Epic

Salesforce

Descripción del empleo

About The Role

eData is looking for a highly analytical Internal Process, Quality, and TAT Auditor to join our Operational Excellence team. In this role, you will be the primary safeguard for our healthcare accounts, ensuring that production teams are hitting their Service Level Agreements (SLAs), maintaining strict HIPAA compliance, and delivering high-quality work. You will look beyond basic defect tracking to understand why errors or delays are happening, working closely with floor leadership to fix bottlenecks and optimize workflows. If you have a strong background in US healthcare—specifically within workers' compensation and med-legal services—and enjoy using data to drive continuous improvement, we want you on our team.

Tasks And Responsibilities

• Audit & Validate: Perform daily quality audits on critical healthcare workflows (including Utilization Review, RCM, and scheduling) to ensure accuracy, clinical/administrative completeness, and strict adherence to client SOPs.
• Monitor Turnaround Time (TAT): Track end-to-end lifecycle times for critical tasks. You will monitor aging reports and unassigned queues to identify friction points and prevent SLA breaches before they happen.
• Drive Root Cause Analysis: When errors occur or TAT is missed, you won't just report it—you will dig into the "why."You will lead Root Cause Analysis (RCA) and collaborate with Operations Supervisors to implement Corrective and Preventive Action (CAPA) plans.
• Process Optimization: Proactively recommend workflow changes, resource realignments, or automation opportunities to improve floor efficiency.
• Coach & Calibrate: Lead regular calibration sessions with Production Department Leadership to review audit findings, bridge knowledge gaps, and ensure the operations team is aligned on quality standards.
• Reporting: Build and maintain daily/weekly quality dashboards detailing error trends, SLA performance, and compliance metrics for operations leadership.

Qualifications

• Industry Experience: 3 to 5 years of experience in the Healthcare BPO/KPO industry, with at least 1–2 years specifically in a Quality Assurance, Auditor, or SME capacity.
• Specialized Domain Knowledge: Proven, hands‑on expertise handling workers' compensation, med-legal services - front office and back office.
• Regulatory Grasp: A strong understanding of US healthcare frameworks, payer/provider dynamics, and strict HIPAA data privacy protocols.
• Analytical Mindset: You are comfortable looking at large datasets, spotting behavioral or procedural trends, and translating those numbers into actionable advice Production Department Leadership.

Technical & Educational Requirements

• Education: Bachelor’s Degree required. (BSN, Physical Therapy, or Allied Health is highly preferred but open to Healthcare Admin or Finance).
• Tech Stack: Advanced Excel/Google Sheets skills (VLOOKUPs, pivot tables, conditional logic). Familiarity with QMS and standard CRM/Workflow platforms (e.g., IMS, Epic, Salesforce).
• AI Aptitude: Strong working knowledge of and comfort using AI tools and AI-assisted workflows to drive data analysis and process efficiency.
• Certifications (Bonus): Lean Six Sigma (Yellow/Green Belt) or Certified Professional Coder (CPC) or Certified Medical Biller/Reviewer is a strong plus.