Quality Assurance Manager - US Healthcare RCM
Zyentara Solutions (Pvt) Limited · Colombo, Western Province, Sri Lanka
Apply & track with Apply EdgeOur client is seeking an experienced Quality Assurance Manager to lead and strengthen the Quality Assurance function across US Healthcare Revenue Cycle Management (RCM) operations.Quality Assurance ManagerKey ResponsibilitiesLead and oversee the Quality Assurance function across multiple RCM processes, ensuring alignment with business objectives, quality standards, and client SLAs.Develop, implement, and continuously improve QA frameworks, audit methodologies, quality standards, and governance processes.Identify process gaps, conduct root cause analyses, and implement corrective and preventive actions to drive sustainable improvements.Identify opportunities to leverage automation and AI to enhance QA processes, improve accuracy, and increase operational efficiency.Monitor quality performance through dashboards, reports, and analytics, providing actionable insights and recommendations to leadership.Ensure adherence to HIPAA, CMS guidelines, payer requirements, and internal quality and compliance standards.Lead, coach, and develop the QA team, fostering a culture of accountability, continuous learning, and performance excellence.Partner with Operations, Technology, Compliance, and Analytics teams to strengthen quality performance and drive process improvements.Participate in client governance meetings, presenting quality metrics, performance trends, root cause findings, and improvement initiatives. Qualifications & ExperienceBachelor’s degree in Healthcare Management, Business Administration, or a related discipline.7+ years of experience in US Healthcare Revenue Cycle Management, including at least 4+ years in Quality Assurance and 3+ years in a people leadership role.Strong knowledge of key RCM functions, including Medical Billing, Accounts Receivable (AR) Management, Denial Management, Payment Posting, and Medical Coding.In-depth understanding of US healthcare regulations, including HIPAA, CMS guidelines, and payer-specific compliance requirements.Proven experience in continuous improvement, process optimization, and root cause analysis, with exposure to Lean, Six Sigma, or similar methodologies.Experience or exposure to automation, AI-enabled solutions, or digital transformation initiatives within healthcare or business process operations is highly desirable.Proficiency in data analysis and reporting tools such as Advanced Excel, Power BI, or Tableau.Professional certifications such as CPC, CCS, CRCP, Lean Six Sigma, or equivalent qualifications will be an added advantage.Strong leadership, stakeholder management, communication, analytical, and problem-solving skills.