RCM Quality Assurance Specialist Full Time NEW

This role sits at the intersection of revenue cycle operations, quality assurance, and AI-driven healthcare workflows, with direct impact on how claims are processed, reviewed, and optimized at scale. You will be responsible for ensuring the highest level of accuracy across both human billing operations and AI-generated outputs in denial management workflows. The environment is fast-moving and data-driven, where precision and continuous improvement are essential. You will audit claim activities, identify error patterns, and transform insights into actionable improvements that enhance performance across teams and systems. As AI becomes increasingly integrated into workflows, this role plays a critical part in maintaining quality standards and ensuring reliability. You will collaborate closely with operations, product, and engineering teams to surface issues and strengthen end-to-end revenue recovery processes. This is a high-ownership role with strong visibility and measurable impact on financial and operational outcomes.

Accountabilities

• Audit claim work to ensure accuracy in actions, documentation, and adherence to established QA standards.
• Review and evaluate AI and human-generated outputs across denial workflows, payer portals, and claims processing activities.
• Identify recurring error patterns, drift, and inconsistencies by comparing outputs against source-of-truth data.
• Build and maintain QA scorecards, trackers, and performance dashboards using Excel, Google Sheets, or BI tools.
• Develop rule-based or automated quality checks to proactively detect and reduce recurring errors.
• Translate error trends into structured feedback and coaching inputs for billing associates and team leads.
• Maintain QA rubrics, calibrate evaluation standards across reviewers, and ensure consistency in scoring.
• Track key quality KPIs, including appeal outcomes, overturn rates, and accuracy metrics.
• Collaborate with product and engineering teams by surfacing reproducible AI or workflow issues.

Requirements

• 4+ years of experience in Revenue Cycle Management (RCM), AR follow-up, or denial management.
• Strong track record of high-accuracy work in fast-paced healthcare billing or claims environments.
• Advanced proficiency in Excel or Google Sheets, including pivot tables, lookups, and conditional logic.
• Strong analytical mindset with the ability to identify root causes rather than surface-level issues.
• Experience reviewing or validating AI-generated outputs is highly desirable.
• Strong documentation skills with the ability to define clear QA standards and processes.
• Ability to work independently and effectively in US time zones (9am-6pm ET).
• Strong communication skills with the ability to provide structured, actionable feedback.
• Exposure to BI tools such as Looker, Tableau, or Metabase is a plus.
• Familiarity with healthcare systems such as ModMed, NextGen, or Athenahealth is an advantage.

Benefits

• Competitive compensation aligned with experience in healthcare RCM and QA roles.
• Fully remote work setup based in India with structured US-hour alignment.
• Opportunity to work at the forefront of AI-driven healthcare revenue cycle innovation.
• High-impact role influencing both operational performance and product improvement.
• Exposure to advanced AI workflows and next-generation denial management systems.
• Strong culture of ownership, autonomy, and continuous learning.
• Collaborative environment working closely with operations, product, and engineering teams.
• Opportunity to contribute to meaningful healthcare outcomes by improving revenue recovery efficiency.

How Jobgether Works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role’s core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.