Assistant Vice President - Quality

• Quality Strategy & Governance

  • . Define and execute the quality strategy for US healthcare RCM operations
  • . Establish quality frameworks, SOPs, control mechanisms, and governance models
  • . Align quality goals with business objectives, client SLAs, and regulatory standards

• RCM Process Quality Oversight

  • . Oversee quality across end-to-end RCM functions:
  • o Patient Access & Registration
  • o Charge Capture & Coding (ICD-10-CM, CPT, HCPCS)
  • o Billing & Claims Submission
  • o Payment Posting & Reconciliation
  • o Denials Management & AR Follow-ups
  • o Credit Balance & Refunds
  • . Ensure accuracy, timeliness, and compliance at each stage of the revenue cycle

• Compliance & Regulatory Management

  • . Ensure adherence to HIPAA, CMS, Medicare, Medicaid, and payer-specific guidelines
  • . Lead internal and external audits (coding, billing, compliance, client audits)
  • . Oversee corrective and preventive action plans (CAPA) and risk mitigation

• Audit, Controls & Risk Management

  • . Design and monitor audit frameworks (transactional, coding, compliance, client audits)
  • . Track error trends, root causes, and systemic issues
  • . Implement strong quality controls to reduce revenue leakage and compliance risk

• Client & Stakeholder Management

  • . Act as the quality SPOC for US clients and internal leadership
  • . Present quality performance, audit findings, and improvement plans to clients
  • . Support client onboarding, transitions, and expansions from a quality standpoint

• Metrics, Analytics & Reporting

  • . Define and track KPIs such as accuracy, TAT, first-pass yield, denial rates, and rework
  • . Leverage data analytics to identify improvement opportunities and predict risks
  • . Drive automation, standardization, and best practices using data insights

• Process Excellence & Continuous Improvement

  • . Lead Lean, Six Sigma, and process improvement initiatives across RCM workflows
  • . Partner with operations, training, and technology teams to improve outcomes
  • . Support RPA, AI, and workflow automation initiatives to enhance quality

• Team Leadership & Capability Building

  • . Lead, mentor, and develop quality, audit, and compliance teams
  • . Build strong coding quality, audit, and regulatory expertise
  • Promote a culture of quality, accountability, and continuous improvement

Job Requirements

• Strong expertise in US Healthcare RCM processes and workflows

• Deep knowledge of medical coding, billing, and payer rules

• Experience with HIPAA, CMS, OIG compliance, and audit standards

• Excellent analytical, problem-solving, and stakeholder management skills

• Strong client-facing communication and executive presentation abilities

Qualifications & Experience

• Any Graduate - Preferred Bachelors degree Business, Quality Management, or related field

• Certifications preferred: CPMA, Six Sigma Black Belt, Lean

• 18+ years of experience in US healthcare RCM quality, audit, or compliance

• Prior leadership experience in healthcare BPO, captive, or provider RCM