The AGM/GM - Quality Analyst (RCM Healthcare) will lead and manage the Quality Assurance function across end-to-end Revenue Cycle Management (RCM) operations. The role is responsible for defining quality frameworks, ensuring compliance with regulatory standards, driving continuous improvement initiatives, and leading a high-performing QA team to deliver accuracy, efficiency, and superior service quality across billing, claims, AR, denials, and collections.

Key Responsibilities:

Quality Framework & Governance:

- Design, implement, and manage a comprehensive QA framework for all RCM operations including billing, claims processing, AR follow-up, denials, appeals, and collections.

- Define, standardize, and enforce QA standards, audit methodologies, evaluation metrics, and quality benchmarks.

- Ensure adherence to internal SOPs, client SLAs, payer guidelines, and regulatory/compliance requirements.

Audit & Compliance:

- Plan and execute regular, periodic, and ad-hoc quality audits across RCM workflows.

- Monitor accuracy, compliance, productivity, and SLA adherence through structured audits and reviews.

- Identify process gaps and compliance risks and recommend corrective actions.

Root Cause Analysis & Improvement:

- Conduct root cause analysis (RCA) for quality issues such as billing errors, claim rejections, denial trends, and rework.

- Drive corrective and preventive action (CAPA) plans in collaboration with operations and training teams.

- Lead continuous improvement initiatives to reduce errors, denials, and turnaround times.

Process Documentation & SOPs:

- Develop, review, and update SOPs, QA manuals, workflows, audit checklists, and quality documentation.

- Ensure documentation aligns with evolving payer rules, regulatory changes, and client requirements.

- Reporting & Management Communication

- Prepare and present quality dashboards, MIS, and performance reports for senior management.

- Track and report metrics such as error rates, first-pass yield, denial trends, audit scores, and improvement outcomes.

- Provide actionable insights and recommendations based on data trends.

Team Leadership & Capability Building:

- Lead, mentor, and manage a team of QA professionals across RCM functions.

- Conduct calibration sessions, performance reviews, and feedback cycles to ensure scoring consistency.

- Identify training needs and support skill development initiatives in collaboration with L&D teams.

Skills & Qualifications:

- Strong expertise in US Healthcare RCM processes: billing, coding interface, claims, AR, denials, and collections.

- Proven experience in QA frameworks, audit models, RCA, and CAPA within RCM operations.

- Strong analytical skills with experience in quality metrics, dashboards, and MIS reporting.

- Leadership experience managing large QA teams and cross-functional stakeholders.

- Excellent communication, stakeholder management, and presentation skills.

Preferred Background:

- Extensive experience in Healthcare RCM Quality Management roles.

- Exposure to multi-client environments and large-scale operations is an advantage.

- Prior experience in senior QA leadership roles (AGM/GM level preferred).

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