RCM Quality Assurance Specialist

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

📋 Description

• Review claim activities for accuracy in actions, issues, and documentation quality in accordance with our QA procedures.

• Evaluate outputs from agents during calls, payer portals, and denial processes, comparing recorded results to the source of truth while identifying error trends and deviations.

• Create and maintain QA scorecards, trackers, and dashboards using Excel or Sheets, contributing to the enhancement of reporting in our BI tools.

• Develop automated or rule-based quality checks that detect recurring errors prior to necessitating manual review.

• Determine the underlying causes of error patterns and convert them into targeted coaching for billing associates and Team Leads.

• Present AI error patterns to the Product and Engineering teams with reproducible, claim-specific details.

• Align QA standards among reviewers, uphold QA rubrics, and assist in achieving our critical-error-free rate objectives.

• Monitor appeal and overturn results along with other quality KPIs.

⛳️ Requirements

• Over 4 years of experience in RCM, AR follow-up, or denial management, showcasing a proven record of high accuracy and productivity.

• Proficient in advanced Excel or Google Sheets (including pivot tables, lookups, conditional logic) and genuinely comfortable handling data.

• A pattern-seeker who investigates root causes instead of merely assessing pass or fail results.

• Detail-oriented and organized, capable of clearly documenting quality standards.

• Comfortable assessing AI-generated outputs and providing structured, actionable feedback.

• Available to work US hours (9am to 6pm ET).

🏝️ Benefits

• Health insurance

• Flexible working hours