QA/ Process Specialist - RCM
Core
Perform quality audits on medical claims, manage work allocation, and generate RCM metrics reports to ensure billing compliance and process improvement.
Role type
Associate RCM Quality & Process Specialist
Builds
Audit reports, compliance checks, and process improvement initiatives for healthcare clients
Domain
Healthcare Revenue Cycle Management (RCM)
Deliverable
dashboards & analysis
Required skills
RCM process knowledge (Billing, Cash Posting, AR, Denial Management), RCM metrics analysis, Quality audit execution, Lean Six Sigma methodologies, Data analysis, MS Excel, MS PowerPoint
Preferred skills
Lean Six Sigma certification
Responsibilities
Perform quality checks/audits on processed claims, ensure compliance with billing rules, prepare daily/weekly/monthly audit metrics reports, analyze data to identify gaps and trends, suggest process improvements, conduct calibration sessions
Seniority
Associate, hands-on IC
