Quality Oversight & Governance

• Own and enforce quality benchmarks across all RCM functions — coding, billing, AR follow-up, denial management, and payment posting
• Establish and maintain quality control checkpoints at each stage of the revenue cycle workflow
• Ensure 100% alignment with CMS guidelines, payer-specific rules, client contractual obligations, and HIPAA/PHI regulations
• Define and manage the monthly/quarterly audit plan, sampling strategies, and QA frameworks

Audit Management & Root Cause Analysis

• Oversee daily, weekly, and monthly transaction audits and calibration sessions across all RCM verticals
• Drive root cause analysis (RCA) for all identified errors and ensure actionable corrective plans are documented and tracked
• Maintain comprehensive audit trails and error logs for regulatory and client review
• Identify recurring defect patterns and escalate critical findings to operations leadership with data-backed reports

Team Leadership & People Management

• Lead, mentor, coach, and manage a team of 20+ QA analysts, ensuring equitable workload distribution and professional growth
• Facilitate regular team huddles, one-on-one feedback sessions, and calibration meetings to promote a quality-first culture
• Identify skill gaps through error trend analysis and develop targeted coaching and upskilling plans
• Act as the first point of escalation for QA analysts and provide real-time guidance and support
• Participate in monthly/quarterly performance reviews for all QA team members in coordination with HR

Performance Management & Analytics

• Track, analyze, and report quality metrics including accuracy rates, defect rates, rework rates, and SLA adherence
• Manage and implement corrective action plans (CAPs) for underperforming analysts and processes
• Align team KPIs with organizational quality goals and report progress to senior leadership
• Monitor Cost of Poor Quality (COPQ) and drive year-on-year reduction targets

Process Improvement & Innovation

• Drive continuous improvement (CI) initiatives to reduce defects, rework, and COPQ using Lean/Six Sigma methodologies
• Design and optimize QA workflows, sampling strategies, and feedback loop mechanisms
• Collaborate with operations, IT, and training teams to implement process changes that improve first-pass accuracy rates
• Evaluate and pilot quality improvement technologies (e.g., AI-powered auditing tools, automation)

Client Engagement & Stakeholder Management

• Lead and participate in client quality calls, review meetings, and audits — presenting quality metrics, trends, and action plans
• Manage and resolve client escalations related to quality issues within defined SLAs
• Support client-specific onboarding by documenting payer rules, quality requirements, and SOPs
• Build and maintain strong client relationships by ensuring consistent delivery of quality benchmarks

Reporting, Documentation & Compliance

• Prepare and share daily/weekly/monthly quality MIS reports, scorecards, and dashboards with leadership
• Maintain up-to-date QA SOPs, error category definitions, calibration logs, and feedback templates
• Design and deliver quality-related training modules for new joiners and refresher programs for existing staff
• Stay current with payer policy changes and disseminate relevant updates to the quality and operations teams

Education & Experience

• Graduate in any discipline; additional certification in Medical Billing / Coding (CPC, CRC, CPMA) preferable
• 9 - 11 years of experience in RCM operations with a minimum of 7 years in a Quality Analyst / Senior QA / Team Lead role
• Proven track record of managing quality teams of 10+ members in a healthcare BPO/KPO environment

Domain Expertise

• In-depth knowledge of Billing , payment posting AR follow-up, denial management, and payer rules
• Strong understanding of HIPAA, PHI, CMS guidelines, and payer-specific compliance requirements
• Experience with EMR/PMS systems) and QA dashboards
• Proficiency in MS Excel (advanced), data analysis, and MIS/dashboard reporting
• Familiarity with Lean/Six Sigma methodologies or process improvement frameworks is a strong plus

Leadership & Soft Skills

• Demonstrated ability to lead, mentor, and drive performance improvements across teams
• Excellent written and verbal communication for client interactions, presentations, and internal reporting
• Strong analytical thinking, problem-solving ability, and attention to detail
• Ability to manage multiple priorities, meet tight deadlines, and thrive in a fast-paced environment
• Effective stakeholder management skills with the ability to influence without authority

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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