Job Description

The QA Process Lead plays a critical role in managing and improving the quality of Accounts Receivable (AR) and Billing Rejection processes within the RCM function. This is an individual contributor role focused on driving accuracy, compliance, and efficiency through audit execution, trend analysis, and collaboration with cross-functional teams. The Process Lead supports continuous improvement initiatives and ensures alignment with client KPIs and internal standards without direct people management responsibilities.
These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job related duties as required. Goals and objectives are subject to change.
All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate.
Essential Functions:Oversee and execute QA audits for AR follow-up and billing rejection workflows. Ensure audit findings comply with internal SOPs and client-specific standards. Identify recurring error trends and provide actionable insights to reduce defects. Collaborate with Operations, Training, and Supervisors to drive process improvements. Generate and present quality reports and dashboards to leadership. Maintain and update audit tools, SOPs, and feedback mechanisms. Support onboarding and mentoring of new QA analysts through knowledge sharing. Participate in calibration sessions with cross-functional teams and clients. Lead root cause analysis (RCA) and assist in preventive action planning (CAPA). Conduct structured report audits to validate QA accuracy and consistency. Align audit practices with client KPIs and internal compliance standards. Facilitate data-driven improvements through regular reporting and analysis. Escalate significant quality or compliance issues with RCA and resolution plans.

Key Results Areas (KRAs)
KRA
Target / Expectation
Weightage
Reporting & Insights
Provide actionable audit reports and trend analysis; escalate and resolve quality issues
20%
Accountability & Responsibilities
Monitor team output; intervene early on performance dips; support coaching and motivation
20%
Resolution & Contribution
Proactively resolve QA bandwidth/capacity issues; ensure SLA adherence
20%
Calibration & Feedback
Enable cross-functional feedback; ensure QA consistency across teams
20%
Escalations
Address escalations promptly with RCA and resolution
20%
Minimum Requirements:
Education/Experience/Certification RequirementsExcellent communication (written and oral) and interpersonal skills. 6-8 years of experience in US Healthcare RCM domain with minimum 2 years of QA experience in AR, Billing Rejection and Payment posting. Strong organizational, multi-tasking, and time-management skills. Must be detail oriented and able to follow through on issues to resolution. Must be able to act both independently and as a team member. Bachelor's degree in healthcare, business, or a related field. Strong domain knowledge in AR, denial management, and billing rejections within RCM. Hands-on experience with QA tools, Practice Management Systems (PMs), and EHRs. Proficiency in MS Excel and data analysis for QA reporting. Excellent communication and interpersonal skills. Ability to manage multiple priorities in a fast-paced environment. High attention to detail with a focus on accuracy and compliance. Exposure to U.S. healthcare payer rules and billing practices.

Preferred Qualifications:Certification in Six Sigma, Lean, or equivalent quality methodologies. Experience working with U.S.-based healthcare clients. Exposure to automation tools (e.g., RPA) and analytics platforms (e.g., Power BI, Tableau). Experience in structured QA reporting and dashboard creation.

Working Environment/Physical Demands

Working Environment:General office environment: Works generally at a desk in a well-lighted, air-conditioned cubicle/office, with moderate noise levels. Periods of stress may occur.

Physical Demands:Activities require a significant amount of sitting at office and work desks and in front of a computer monitor. Some walking and standing relative to interaction with other personnel.

Travel Requirements:
None Occasional Moderate Frequent Very Frequent
(25% or Less) (25% - 40%) (40% - 80%) (80% or more)
Other possible Unofficial Titles:
Unofficial titles may be given by the manager and used for calling cards and email signatures.Note: Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This document does not create an employment contract, implied or otherwise. It does not alter the "at will" employment relationship between the company and the employee.
Individual Contributor