Senior Quality Assurance Manager - Revenue Cycle Management (RCM) - Work From Home

ClinicMind is a leading provider of comprehensive healthcare practice management software and service platform for a full patient care cycle. We are seeking an experienced and analytical Senior Quality Assurance Manager to lead our Quality Assurance (QA) teams in monitoring, evaluating, and improving the performance of our Revenue Cycle Management (RCM) operations. This role is focused on identifying and addressing errors, analyzing root causes, recommending process improvements, and supporting personnel optimization to ensure operational excellence. The ideal candidate will combine a deep understanding of RCM processes with an ability to drive high-quality deliverables and measurable improvements.

Key Responsibilities:

1. • Quality Assurance Operations

     • Oversee QA teams responsible for identifying errors made by RCM teams during insurance claim processing, follow-up, and resolution.

     • Develop and enforce QA standards and evaluation metrics to ensure consistent, accurate, and thorough discovery of errors.

     • Regularly audit RCM processes and outputs, providing detailed reports on findings to leadership.

     Root Cause Analysis and Process Improvement

     • Conduct in-depth root cause analyses for identified errors to uncover systemic issues or gaps in training, technology, or processes.

     • Collaborate with stakeholders to propose updates to Standard Operating Procedures (SOPs) to eliminate recurring errors and improve workflow efficiency.

     • Monitor the effectiveness of implemented changes, ensuring sustainable improvements over time.

     Recommendations to Leadership

     • Provide detailed recommendations to RCM managers regarding personnel performance, identifying strengths and areas for development among team members engaged in claims follow-up.

     • Partner with HR and training teams to address identified skill gaps through targeted training programs.

     • Facilitate regular feedback loops between QA and RCM teams to promote accountability and knowledge-sharing.

     Team Leadership & Development

     • Manage and mentor QA staff, fostering a culture of accuracy, objectivity, and continuous improvement.

     • Conduct regular team performance reviews and provide guidance to ensure high-quality deliverables.

     • Develop and deliver training sessions on quality standards and evolving RCM best practices.

     Data-Driven Decision Making

     • Utilize analytics tools and QA software to track and report key quality metrics.

     • Identify trends in errors and develop proactive strategies to prevent them.

     • Establish a dashboard for real-time monitoring of QA performance and share insights with leadership.

      

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     Key Performance Indicators (KPIs):

     1. Error Detection:

     • Discovery of 100% of critical errors and 95% of non-critical errors across all RCM processes.

     2. Root Cause Analysis:

     • Completion of comprehensive root cause analyses for 100% of identified errors within five business days.

     3. Process Improvement Implementation:

     • SOP updates proposed and implemented for 100% of recurring errors with measurable impact.

     4. Team Recommendations:

     • Actionable personnel recommendations provided to managers within five business days of review completion.

     5. Error Recurrence Reduction:

     • Achieve a 50% reduction in recurring errors within the first 90 days of process improvement implementation.

     6. Claim Accuracy Rate:

     • Maintain a 99% claim accuracy rate across all teams audited.

     7. Timeliness:

     • QA audits completed and feedback provided to RCM teams within 48 hours of claim processing.

      

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     Qualifications:

     • Bachelor’s degree in healthcare administration, business administration, or a related field. Master’s degree preferred.

     • Minimum of 8 years of experience in RCM or healthcare quality assurance roles, with proven leadership in QA processes.

     • Expertise in healthcare billing, coding, reimbursement processes, and claim management workflows.

     • Strong understanding of QA methodologies and process improvement techniques, such as Six Sigma or Lean principles.

     • Proficiency in QA software, RCM systems, and data analytics tools.

     • Exceptional analytical, communication, and problem-solving skills.

     • Proven ability to manage and mentor teams effectively.

      

     Position Requirements

     • Must have stable internet connection minimum of 5 MBPS

     • Must have a mobile data plan as a backup

     • Must be in a quiet environment

     • Must be comfortable working the US business hours

     • Must own a PC with at least 16 GB of memory