The Quality Manager is responsible for overseeing and enhancing quality assurance processes across all RCM functions, billing, AR follow\-up, and denial management. This role ensures compliance with client requirements, regulatory standards, and internal benchmarks while driving continuous improvement and operational excellence.**Key Responsibilities****1\. Quality Assurance \& Auditing*** + Develop and implement quality assurance frameworks across RCM processes
+ Conduct regular audits of coding, billing, and AR processes
+ Ensure adherence to payer guidelines, client SOPs, and regulatory standards (HIPAA, CMS, etc.)
+ Monitor accuracy, productivity, and compliance metrics
+ Drive continuous improvement initiatives (Lean, Six Sigma, etc.)
+ Collaborate with operations teams to reduce denials and improve first\-pass yield
+ Standardize best practices across teams
+ Set performance goals and KPIs for the quality team
+ Conduct regular training and calibration sessions
+ Ensure consistency in audit scoring and feedback
+ Track KPIs such as accuracy rates, denial rates, turnaround time, and rework
+ Provide actionable insights to improve operational performance
+ Conduct internal compliance audits
+ Support external audits and client reviews
+ Mitigate risks related to billing errors and revenue leakage
+ Participate in client calls and business reviews
+ Address client escalations related to quality issues
+ Align quality goals with client expectations
+ 12–15 years of experience in RCM with at least 3\+ years in a quality leadership role
+ Expertise in medical coding, billing, and denial management
+ Analytical and problem\-solving skills
+ Leadership and stakeholder management
+ Excellent communication and presentation skills
+ Familiarity with quality tools and methodologies
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