Assistant Vice President - Quality

Job Location: Noida, India

Job Description

  • 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  Bachelor’s 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

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