Internal Process, Quality & TAT Auditor Healthcare Operations

eData Services US, L.L.C.; Taguig; On-site; PHP 450,000 - 850,000; Full time

Job summary

eData Services US, L.L.C. seeks an Internal Process, Quality & TAT Auditor to safeguard healthcare operations in Taguig. Audit critical workflows like Utilization Review, RCM, and scheduling while enforcing HIPAA and SLA adherence.

You will analyze data to uncover bottlenecks, lead root cause analysis, and drive CAPA with Operations Supervisors. The role emphasizes proactive process optimization and daily/weekly quality reporting to leadership.

Qualifications

• Bachelor's degree required with healthcare admin/finance acceptable.
• Proven ability to analyze large datasets and translate findings into actions.
• Experience with US healthcare workflows and HIPAA is preferred.
• Familiarity with QA, auditing, or SME roles in healthcare BPO.

Responsibilities

• Audit and validate daily healthcare workflows to ensure accuracy and SOP adherence.
• Monitor end-to-end TAT and aging reports to prevent SLA breaches.
• Lead RCA and coordinate CAPA with Operations Supervisors.
• Suggest workflow changes and automation to improve floor efficiency.
• Lead calibration sessions with Production Department Leadership.
• Prepare daily/weekly dashboards on errors, SLA performance, and compliance.

Skills

Analytical Mindset

Advanced Excel/Google Sheets

AI tools familiarity

Education

Bachelor's Degree

Lean Six Sigma Yellow/Green Belt

CPC Certification

Tools

QMS

IMS

Epic

Salesforce

Job description

Internal Process, Quality & TAT Auditor – Healthcare Operations

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.