Director Quality Operations

The Director of Quality for Revenue Cycle Management in US Healthcare would be responsible for overseeing the quality of revenue cycle management operations, ensuring that all processes are executed efficiently and accurately, and that compliance with all relevant regulations and guidelines is maintained. The Director will lead a team of quality analysts to identify opportunities for improvement, develop and implement quality assurance programs, and ensure that all activities are aligned with organizational goals and objectives.

Key Responsibilities:

Lead the development and implementation of quality assurance programs for Pre Auth operations, including audit protocols, metrics, and reporting mechanisms.

Identify and prioritize areas for improvement based on data analysis, industry benchmarks, and best practices.

Lead client calls and publish quality metrics, root cause analysis, opportunity areas and action plan.

Develop and deliver training programs to educate staff on quality assurance procedures, policies, and regulations.

Collaborate with other departments to establish performance metrics, monitor key performance indicators, and ensure alignment with overall organizational goals and objectives.

Conduct periodic reviews of revenue cycle management processes, policies, and procedures to identify areas for improvement and ensure compliance with all relevant policy and guidelines.

Ensure that all quality assurance activities are documented and reported accurately and timely.

Foster a culture of continuous improvement, teamwork, and accountability among staff, providing guidance and support as needed.

Keep abreast of industry trends and developments and provide recommendations for enhancements to the revenue cycle management program.

Qualifications:

Minimum 12 years of experience in revenue cycle management in US healthcare, with at least 3 years in a quality assurance role. Pre authorization experience is must.

In-depth knowledge of relevant guidelines, including HIPAA, Medicare, Blue, Commercial and Medicaid.

Strong analytical skills with the ability to analyze complex data and make informed decisions.

Demonstrated ability to lead and manage a team, develop and implement quality assurance programs, and drive continuous improvement.

Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders.

Strong organizational skills with the ability to manage multiple priorities and meet deadlines.

Certification in quality management, such as Six Sigma, is a plus.