Manager Quality Assurance

Role Summary

HealthRecon Connect is a technology-enabled healthcare Revenue Cycle Management (RCM) partner to US healthcare providers. We are looking for an experienced and forward-thinking Manager – Quality Assurance to lead our QA function within US Healthcare Revenue Cycle Management operations. This role involves building a strong, insight-led QA function that supports operational excellence, reduces errors, improves denial prevention, strengthens compliance, and drives continuous improvement.

Key Responsibilities

• Designing, implementing, and continuously improving the QA framework across RCM processes (Billing, Coding, AR Follow-Up, Denials, Payment Posting).
• Developing risk-based audit and sampling approaches focusing on high-impact areas.
• Establishing quality governance practices including calibration, error taxonomy, root-cause analysis, CAPA tracking, and trend reporting.
• Partnering with Operations leaders to identify recurring quality issues and drive corrective and preventive actions.
• Leading continuous improvement initiatives using Lean, Six Sigma, or similar methodologies.
• Building QA dashboards and reporting mechanisms for internal and client stakeholders.
• Identifying opportunities to automate repetitive QA activities and supporting AI/automation initiatives.
• Leading, coaching, and developing QA analysts and auditors.
• Supporting client governance discussions, business reviews, and quality-related stakeholder updates.

Requirements/Qualifications

• 8–10 years of experience in the US Healthcare RCM industry.
• Minimum 4–5 years of experience in QA, quality audit, or quality assurance within RCM.
• At least 3 years of experience leading a QA team.
• Strong hands-on knowledge of RCM areas (Medical Billing, AR Management, Denial Management, Medical Coding, Payment Posting).
• Good understanding of US payer processes, claim adjudication, denial taxonomy, remittance processing, and payer requirements.
• Knowledge of HIPAA, CMS guidelines, and payer-specific compliance requirements.
• Experience in QA methodologies, audit design, sampling, RCA, CAPA, and quality governance.
• Strong analytical skills with working knowledge of Excel, Power BI, Tableau, or similar reporting tools.
• Exposure to automation, RPA, AI tools, or technology-enabled quality solutions is an added advantage.
• Excellent communication, stakeholder management, and presentation skills.
• Ability to work in a fast-paced, high-volume environment.

Qualifications and Certifications

• Bachelor’s degree in Healthcare Management, Business Administration, or a related field is preferred.
• CPC, CCS, CRCP, or similar RCM-related certification is an advantage.
• Lean Six Sigma Green Belt or above is a strong advantage.
• Certification or training in automation or AI tools related to healthcare/BPO operations is an added advantage.

Location

India / Sri Lanka (India: Remote; Sri Lanka: Hybrid - Minimum 3 Days/Week in Office)