RCM Quality Analyst

About the Role:

We are seeking a sharp, detail-oriented
Quality Analyst with proven experience in U.S. Healthcare Revenue Cycle Management (RCM)
to join our growing team. This role is critical in ensuring accuracy, compliance, and process excellence across the entire RCM lifecycle—from End-to-End. If you have a passion for quality, a strong understanding of billing workflows, and a keen eye for detail, we'd love to hear from you.

Key Responsibilities:

• Understand the end-to-end revenue cycle, including Eligibility & Benefits Verification, Authorization, Charge Entry, Claims Submission, AR Follow-up, Denial Management, and Payment Posting, to understand the complete workflows, recommend improvements, and create quality parameters to maintain accuracy in production.
• Conduct daily quality audits and share constructive feedback with team members on a weekly or monthly basis for all RCM functions.
• Identify errors in accounts, audit trends, and training needs to improve team performance and production accuracy.
• Generate comprehensive reports on quality performance for individuals and the team.
• Track and report key quality metrics, driving continuous improvement initiatives.
• Ensure compliance with HIPAA, CMS, payer regulations, and client-specific protocols.
• Design assessments and conduct evaluations to reinforce quality standards and ensure consistent performance across projects.
• Validate HIPAA-compliant claim files, payer rules, CPT/ICD code mapping, and insurance-specific workflows.
• Collaborate with cross-functional teams, including operations, training, developers, and business analysts, to support process enhancements

Required Qualifications:

• In-depth knowledge of end-to-end RCM workflows: Eligibility & Benefits Verification, Authorization, Charge Entry, Claims Submission, AR Follow-up, Denial Management, and Payment Posting.
• 1–5 years of experience as a Quality Auditor in U.S. Healthcare RCM/Medical Billing.
• Solid understanding of HIPAA and healthcare data privacy standards
• Excellent attention to detail, written & verbal communication, and analytical skills
• Experience with billing or practice management platforms (e.g., Kareo, AdvancedMD, eClinicalWorks, Athena, Epic, or Cerner) and also in payor portals
• Experience in QA from diverse industries will be regarded as a strong plus.

Following certifications are preferred, but not mandatory:

• Lean Six Sigma (Green Belt / Black Belt): For reducing errors, improving workflows, and driving operational efficiency.
• Certified Quality Auditor (CQA) – ASQ: For professionals conducting audits of quality systems and processes.
• Project Management Professional (PMP): For managing cross-functional QA and system improvement projects.
• Certified Health Data Analyst (CHDA) – AHIMA: For analyzing healthcare data to improve billing and QA outcomes.
• SQL/Data Analytics Certifications (Microsoft, Oracle, Coursera): For backend validation and reporting.

Why Join Us:

• Opportunity to work with a dynamic team of professionals and achieve growth and expertise in your chosen field.
• Competitive salary, bonuses, and comprehensive benefits package.
• Ready to take your design and development game to the next level? Join us