RCM Process & Quality Analyst Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Spearhead the design, implementation, and ongoing enhancement of the RCM audit strategy.

• Create and manage audit programs for both internal and vendor interactions.

• Direct and oversee call quality assessments and performance evaluation programs.

• Formulate, standardize, and supervise RCM scorecards, key performance indicators (KPIs), and performance frameworks.

• Lead SOX compliance initiatives, which include control design and oversight of execution.

• Act as the main liaison for Internal Audit and Compliance matters.

• Govern the management of payer portal access controls and offshore restrictions.

• Supervise the validation of payer contracts and the configuration of systems.

• Drive process improvement efforts by defining future-state workflows.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare revenue cycle or related operational roles.

• Comprehensive understanding of LCDs/NCDs, payer agreements, claims processing, denial codes, and reimbursement processes.

• Proven expertise in SOX compliance within the medical billing sector, including control design, execution, and governance.

• Demonstrated success in leading cross-functional projects, influencing stakeholders, and facilitating organizational change.

• Experience collaborating with Internal Audit, Compliance, or external auditors, including accountability for audit results and remediation actions.

• High level of proficiency in Microsoft Excel (including pivot tables, VLOOKUP, macros, etc.).

• Familiarity with CRM platforms, particularly Salesforce.

• Bachelor's degree in Healthcare Administration, Health Information Management, Business Administration, Finance, or a related field; or equivalent professional experience.

🏝️ Benefits

• Health insurance

• Opportunities for professional development