SDM Quality - RCM

The Opportunity

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.

Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.

Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.

Join our team as the expert you are now and create your future.

Position Summary

Job Summary:
We are looking for a highly motivated and detail-oriented HMS Quality Manager to oversee the quality assurance and quality control processes within our Healthcare Managed Services (RCM & Coding) department. The successful candidate will be responsible for developing, implementing, and maintaining quality standards and procedures to ensure the reliability, accuracy, and compliance of our HMS services. The Quality Manager will collaborate closely with cross-functional teams to drive continuous improvement projects, Quality Assurance and Control and uphold our commitment to excellence.

Qualifications

Job Summary:
We are looking for a highly motivated and detail-oriented HMS Quality Manager to oversee the quality assurance and quality control processes within our Healthcare Managed Services (RCM & Coding) department. The successful candidate will be responsible for developing, implementing, and maintaining quality standards and procedures to ensure the reliability, accuracy, and compliance of our HMS services. The Quality Manager will collaborate closely with cross-functional teams to drive continuous improvement projects, Quality Assurance and Control and uphold our commitment to excellence.

**Key Responsibilities:**

1. **Quality Assurance Strategy: ** Develop and implement a comprehensive quality assurance strategy for RCM & Coding services, aligned with organizational goals and objectives.

2. **Quality Standards and Procedures: ** Establish and maintain quality standards, policies, and procedures to ensure the reliability, accuracy, and compliance of HMS solutions with industry regulations and best practices.

3. **Quality Control Processes: ** Implement robust quality control processes, including sampling protocols, calibration, and coaching, to identify and address any deficiencies or deviations from quality standards (process or user level).

4. **Compliance Management: ** Ensure compliance with relevant healthcare regulations, data security standards, and industry certifications, such as HIPAA, HITECH, and HITRUST, ISO 27001, etc.

5. **Performance Monitoring: ** Monitor and analyze performance metrics and key performance indicators (KPIs) to assess the effectiveness of quality assurance efforts and identify areas for improvement.

6. **Risk Management: ** Identify potential risks and vulnerabilities within RCM and Coding services, conduct risk assessments, and develop risk mitigation strategies to safeguard against quality-related incidents.

7. **Customer Satisfaction: ** Collaborate with customers, stakeholders, and end-users to gather feedback, address concerns, and enhance customer satisfaction with HMS solutions.

8. **Continuous Improvement: ** Lead and support continuous improvement initiatives, including root cause analyses, corrective actions, and preventive measures, to drive ongoing enhancements to HMS quality and performance, including but not limited to Automation and Tech leverage.

9. **Documentation and Reporting: ** Maintain accurate documentation of quality assurance activities, audit findings, compliance records, and performance metrics. Prepare and present reports on quality metrics, trends, and performance to Leadership.

**Qualifications: **

• Bachelor's degree in Business Administration, Computer Science, Engineering, or related field. Master's degree preferred.

• Minimum of 5 years of experience in quality assurance, quality management, or related field, preferably in the healthcare or customer service industry.

• Strong understanding of US healthcare Revenue cycle Management and Coding and Quality Assurance methodologies.

• In-depth knowledge of healthcare regulations, data security standards, and industry certifications, such as HIPAA, HITECH, and HITRUST, ISO 9001, 27001 preferred.

• Lean, Six Sigma, Project Management practical experience and certification preferred.

• Experience in conducting internal compliance audits is preferred.

• Excellent analytical skills and attention to detail, with the ability to conduct thorough assessments, analyses, and evaluations.

• Strong communication, leadership, and interpersonal skills, with the ability to collaborate effectively with cross-functional teams and stakeholders.

Posting Category

Healthcare

Opportunity Type

Regular

Country

India