RCM Quality Assurance Specialist
New
Fully remote work setup based in India, US time zones (9am–6pm ET)Full-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 4+ years
- Required Skills
- Data AnalysisTableauMicrosoft ExcelQuality AssuranceGoogle SheetsLooker
Requirements
- 4+ years of experience in Revenue Cycle Management (RCM), AR follow-up, or denial management.
- Strong track record of high-accuracy work in fast-paced healthcare billing or claims environments.
- Advanced proficiency in Excel or Google Sheets, including pivot tables, lookups, and conditional logic.
- Strong analytical mindset with the ability to identify root causes.
- Experience reviewing or validating AI-generated outputs is highly desirable.
- Strong documentation skills.
- Ability to work independently and effectively in US time zones (9am–6pm ET).
- Strong communication skills.
- Exposure to BI tools such as Looker, Tableau, or Metabase is a plus.
- Familiarity with healthcare systems such as ModMed, NextGen, or Athenahealth is an advantage.
Responsibilities
- Audit claim work to ensure accuracy in actions, documentation, and adherence to established QA standards.
- Review and evaluate AI and human-generated outputs across denial workflows, payer portals, and claims processing activities.
- Identify recurring error patterns, drift, and inconsistencies by comparing outputs against source-of-truth data.
- Build and maintain QA scorecards, trackers, and performance dashboards using Excel, Google Sheets, or BI tools.
- Develop rule-based or automated quality checks to proactively detect and reduce recurring errors.
- Translate error trends into structured feedback and coaching inputs for billing associates and team leads.
- Maintain QA rubrics, calibrate evaluation standards across reviewers, and ensure consistency in scoring.
- Track key quality KPIs, including appeal outcomes, overturn rates, and accuracy metrics.
- Collaborate with product and engineering teams by surfacing reproducible AI or workflow issues.
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