QA/ Process Specialist - RCM

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise. Join our team as the expert you are now and create your future. As an RCM QA/ Process Specialist, you will be responsible for team handling, audits, work allocation, client interactions and generate distribute RCM metrics reports to the leadership team. Excellent communication skills, attention to detail, and strong technical and problem-solving skills are essential aspects of this role Job Description • Thorough understanding of RCM processes like Billing, Cash Posting, Credit Balance, Accounts Receivables, Denial Management & Correspondence review • Very good understanding of RCM metrics like Days in AR, Ageing above 90 days, Collections and bad debt • Perform Quality checks/audits on all claims processed as per quality policy or as per client SOP • Responsible for getting the claims processed in compliance to the billing rules mentioned and ensure all errors are identified in QA and actions initiated before the claim is rebilled to the insurance • Implement Lean Six sigma mythologies to improve the accuracy of the processes • Consistently review the audit parameters and modify as per the necessary requirement • Prepare daily, weekly & monthly audit metrics reports and share it with leadership • Conduct analysis and present summary of findings to leadership in a clear, concise, convincing and actionable format • Establish a strong relationship with Team Leaders / Managers by demonstrating the gaps, trends & patterns identified during the data/report compilation • Suggest ways of improvements and set up calibration sessions with onshore and internal teams • Develops documentation of quality related MIS work to have smooth operations and easy system maintenance QUALIFICATIONS: • 3+ years of industry experience