RCM Associate Manager - Quality

Job Description Summary :

The Associate Manager – Quality, RCM is responsible for leading, monitoring, and continuously improving the quality assurance function within Revenue Cycle Management operations. This is a people-plus-process leadership role that combines hands-on audit governance with team management, client engagement, and strategic quality improvement.

You will serve as the primary quality ambassador between operations, clients, and senior leadership — ensuring compliance with payer guidelines, HIPAA regulations, and internal SOPs while driving performance excellence across all QA analysts. You will own the quality scorecard, shape audit strategy, and build a culture of accountability and continuous learning within your team.

Quality Oversight & Governance

Own and enforce quality benchmarks across all RCM functions — coding, billing, AR follow-up, denial management, and payment posting

Establish and maintain quality control checkpoints at each stage of the revenue cycle workflow

Ensure 100% alignment with CMS guidelines, payer-specific rules, client contractual obligations, and HIPAA/PHI regulations

Define and manage the monthly/quarterly audit plan, sampling strategies, and QA frameworks

Audit Management & Root Cause Analysis

Oversee daily, weekly, and monthly transaction audits and calibration sessions across all RCM verticals

Drive root cause analysis (RCA) for all identified errors and ensure actionable corrective plans are documented and tracked

Maintain comprehensive audit trails and error logs for regulatory and client review

Identify recurring defect patterns and escalate critical findings to operations leadership with data-backed reports

Team Leadership & People Management

Lead, mentor, coach, and manage a team of 20+ QA analysts, ensuring equitable workload distribution and professional growth

Facilitate regular team huddles, one-on-one feedback sessions, and calibration meetings to promote a quality-first culture

Identify skill gaps through error trend analysis and develop targeted coaching and upskilling plans

Act as the first point of escalation for QA analysts and provide real-time guidance and support

Participate in monthly/quarterly performance reviews for all QA team members in coordination with HR

Performance Management & Analytics

Track, analyze, and report quality metrics including accuracy rates, defect rates, rework rates, and SLA adherence

Manage and implement corrective action plans (CAPs) for underperforming analysts and processes

Align team KPIs with organizational quality goals and report progress to senior leadership

Monitor Cost of Poor Quality (COPQ) and drive year-on-year reduction targets

Process Improvement & Innovation

Drive continuous improvement (CI) initiatives to reduce defects, rework, and COPQ using Lean/Six Sigma methodologies

Design and optimize QA workflows, sampling strategies, and feedback loop mechanisms

Collaborate with operations, IT, and training teams to implement process changes that improve first-pass accuracy rates

Evaluate and pilot quality improvement technologies (e.g., AI-powered auditing tools, automation)

Client Engagement & Stakeholder Management

Lead and participate in client quality calls, review meetings, and audits — presenting quality metrics, trends, and action plans

Manage and resolve client escalations related to quality issues within defined SLAs

Support client-specific onboarding by documenting payer rules, quality requirements, and SOPs

Build and maintain strong client relationships by ensuring consistent delivery of quality benchmarks

Reporting, Documentation & Compliance

Prepare and share daily/weekly/monthly quality MIS reports, scorecards, and dashboards with leadership

Maintain up-to-date QA SOPs, error category definitions, calibration logs, and feedback templates

Design and deliver quality-related training modules for new joiners and refresher programs for existing staff

Stay current with payer policy changes and disseminate relevant updates to the quality and operations teams

WHAT WE’RE LOOKING FOR

Education & Experience

Graduate in any discipline; additional certification in Medical Billing / Coding (CPC, CRC, CPMA) preferable

9 - 11 years of experience in RCM operations with a minimum of 7 years in a Quality Analyst / Senior QA / Team Lead role

Proven track record of managing quality teams of 10+ members in a healthcare BPO/KPO environment

Domain Expertise

In-depth knowledge of Billing , payment posting AR follow-up, denial management, and payer rules

Strong understanding of HIPAA, PHI, CMS guidelines, and payer-specific compliance requirements

Experience with EMR/PMS systems) and QA dashboards

Proficiency in MS Excel (advanced), data analysis, and MIS/dashboard reporting

Familiarity with Lean/Six Sigma methodologies or process improvement frameworks is a strong plus

Leadership & Soft Skills

Demonstrated ability to lead, mentor, and drive performance improvements across teams

Excellent written and verbal communication for client interactions, presentations, and internal reporting

Strong analytical thinking, problem-solving ability, and attention to detail

Ability to manage multiple priorities, meet tight deadlines, and thrive in a fast-paced environment

Effective stakeholder management skills with the ability to influence without authority

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture , Benefits , Early Talent Program , and Additional Openings .

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

From a "VEVRAA Federal Contractor" We request Priority Referral of Protected Veterans

This is an official Veradigm Job posting. To avoid identity theft, please only consider applying to jobs posted on our official corporate site.

Thank you for reviewing this Veradigm opportunity. Does this look like a great match for your skill set? If so, scroll on down and tell us more about yourself!