Quality Analyst- AR (US Healthcare)

Role Overview :

The Quality Analyst will be responsible for evaluating the accuracy and effectiveness of RCM processes including billing, and AR. The role ensures adherence to client SOPs, identifies training needs through audit insights, and maintains comprehensive MIS dashboards to support performance tracking and process optimization.

Key Responsibilities :

Quality Auditing :

Conduct regular audits for RCM processes such as charge entry, payment posting, and AR follow-up .

Ensure compliance with client SOPs, payer rules, and HIPAA standards.

Identify accuracy trends, recurring errors, and process gaps; share insights with team leads and managers.

Participate in calibration and feedback sessions to align on quality standards and expectations.

Prepare daily / weekly / monthly audit reports highlighting performance, trends, and improvement areas.

Support process owners in implementing corrective and preventive actions.

MIS & Reporting :

Develop and maintain MIS dashboards covering productivity, quality, attendance, and TAT adherence.

Track team and individual metrics for various RCM functions (billing, AR, payment posting, etc.).

Generate reports for internal and client reviews on periodic basis.

Support management with data-driven insights to aid decision-making and operational planning.

Automate reports and streamline data consolidation to improve reporting efficiency.

Process Improvement & Coordination :

Collaborate with operations and training teams to address performance and quality concerns.

Assist in root cause analysis of audit findings and contribute to process refinement.

Document process deviations and best practices; ensure timely version control and communication.

Support calibration and refresher sessions to strengthen process understanding.

Key Skills & Competencies :

Strong understanding of US Healthcare RCM processes (Charge Entry, Payment Posting, AR Follow-up, Denial Management).

In-depth knowledge of quality metrics and RCM performance indicators (Productivity %, Accuracy %, TAT, DSO).

Proficiency in MS Excel (Pivot, Lookup, Conditional Formatting, Charts, Dashboarding).

Exposure to Power BI / Google Data Studio for data visualization (preferred).

Strong analytical, reporting, and problem-solving skills.

Excellent written and verbal communication.

Detail-oriented, organized, and able to handle multiple deliverables with accuracy.

Qualification :

Any graduate with minimum 2 years of experience in Quality Audit in AR, US healthcare processes.

Certification in Quality, Data Analytics, or RCM processes is a plus.