Senior Manager, Quality RCM

3 days ago

Pasig, National Capital Region, Philippines Med-Metrix Full time
Job Description

Posted Sunday, February 16, 2025 at 4:00 PM

Join our dynamic team and make a meaningful impact in the healthcare industry. Enjoy competitive benefits upon hire, ongoing professional development, and the satisfaction of helping others every day. Take the next step in your career with Med-Metrix

Experience these exceptional benefits when you join Med-Metrix

  • Day 1 HMO with 2 of your dependents covered for FREE
  • Clothing Allowance
  • Free Lunch Daily
  • Paid Time Off
  • Training and Staff Development
  • Employee Engagement Activities
  • Opportunities for Internal Mobility

The Senior Manager, Quality RCM will lead the QA processes within the AR Department and will report to the Training and Quality Director. This role is responsible for ensuring accurate billing, identifying compliance risks, managing quality audits, and driving improvement initiatives. The ideal candidate has extensive knowledge of forensic healthcare billing, AR processes, and QA methodologies. This role also requires strong analytical skills, attention to detail, and experience with healthcare regulatory requirements.

Duties and Responsibilities

  • Quality Assurance Leadership: Develop and implement a comprehensive quality assurance program for accounts receivable in forensic healthcare, focused on accuracy, compliance, and efficiency. Establish and maintain QA standards, policies, and procedures that align with healthcare compliance regulations, industry best practices, and company objectives. Lead and mentor the AR QA team, providing guidance, training, and performance feedback to ensure quality objectives are met.
  • Compliance and Risk Management: Ensure that all AR processes comply with regulatory standards, including HIPAA, FCRA, and other forensic healthcare requirements. Conduct regular audits to assess risk, ensure data integrity, and verify compliance with internal and external standards. Collaborate with legal and compliance departments to address issues related to billing, collections, and data privacy.
  • AR Process Oversight and Improvement: Review, analyze, and optimize AR processes for forensic healthcare accounts, focusing on error reduction and improving cash flow. Develop key performance indicators (KPIs) for AR quality and track metrics to identify trends, areas of improvement, and potential process enhancements. Implement corrective actions for recurring issues and establish preventive measures to ensure long-term AR quality.
  • Audit Management: Plan and conduct internal audits of accounts receivable processes, ensuring compliance with legal, regulatory, and company standards. Prepare detailed audit reports, document findings, and present recommendations for improvement to senior management. Coordinate with external auditors as needed and support documentation requests during external audits.
  • Data Analysis and Reporting: Analyze data from AR operations to identify quality issues, gaps, and areas for improvement, using insights to drive strategic changes. Provide detailed reports to senior leadership on AR quality metrics, audit results, compliance issues, and corrective actions taken. Utilize data analysis tools to generate actionable insights that help refine AR processes and support decision-making.
  • Collaboration and Stakeholder Communication: Work closely with revenue cycle, finance, compliance, and legal teams to address quality concerns, share best practices, and support cross-departmental goals. Regularly communicate QA findings, audit results, and process improvements to stakeholders, ensuring alignment on AR quality objectives. Serve as a liaison between AR teams and other departments to foster collaboration and ensure quality objectives are integrated throughout operations.

Qualifications

  • 8+ years of experience in accounts receivable, revenue cycle management, or forensic healthcare, with a minimum of 5 years in a quality assurance leadership role.
  • Proven experience managing AR processes within a forensic healthcare setting or similar regulated environment.
  • Strong knowledge of forensic healthcare compliance standards, including HIPAA, FCRA, and healthcare AR best practices.
  • Demonstrated ability to lead audits, analyze complex data, and provide actionable recommendations.
  • Proficient in data analysis tools, such as Excel, SQL, and specialized AR or QA software.
  • Excellent communication, leadership, and problem-solving skills.
  • Strong written and verbal communication skills, with the ability to present complex information clearly.
  • Certification in healthcare compliance or quality assurance, such as CHC, CPC, or CQA.
  • Familiarity with AR automation tools and ERP systems (e.g., Epic, SAP, Oracle).
  • Experience implementing quality improvement programs or Six Sigma methodology.

Working Conditions

  • Work Set-Up: Onsite
  • Work Schedule: Night shift, US hours
  • Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals, and telephones; extend arms; kneel; talk; and hear.
  • Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
  • Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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