RCM Team Leader – Quality

Team Supervision & People Management

• Supervise, mentor, and manage a team of 8–15 Quality Auditors; ensure equitable workload distribution and shift coverage.
• Conduct daily team huddles, weekly one-on-one check-ins, and monthly performance reviews to drive individual and team growth
• Act as the first point of escalation for auditor queries, quality disputes, and operational challenges
• Identify skill gaps through error trend analysis and design targeted coaching plans with measurable improvement timelines
• Manage attendance, leave planning, and team roster to maintain uninterrupted audit coverage
• Support hiring, onboarding, and probation assessments for new QA team members in coordination with HR

Quality Auditing & Oversight

• Review and validate a defined sample of audits completed by team members to ensure accuracy and consistency
• Conduct second-level / supervisory audits across RCM verticals (billing, AR, denials, payment posting) against defined quality parameters
• Ensure the team achieves 100% audit coverage against the monthly audit plan and meets all SLA commitments
• Perform calibration audits to maintain inter-rater reliability (≥95%) across all auditors
• Monitor and enforce zero-tolerance for critical compliance errors; escalate immediately to the Associate Manager

Root Cause Analysis & Corrective Actions

• Lead root cause analysis (RCA) for recurring error patterns and systemic defects across the team’s audit scope
• Design, implement, and track corrective action plans (CAPs) to closure; verify effectiveness post-correction
• Prepare weekly error trend analysis and RCA summaries for review by the Associate Manager
• Classify errors into defined categories (critical, non-critical, process-based, knowledge-based) and maintain comprehensive error logs

Training & Calibration

• Design and deliver refresher training programs, error-specific workshops, and new-joiner induction sessions
• Facilitate regular calibration sessions with auditors to align interpretation of quality standards and scoring rubrics
• Create and maintain error reference guides, job aids, and SOPs for the auditing team
• Track training effectiveness through post-training assessments and ensure ≥90% improvement scores

Reporting & MIS

• Prepare and submit daily, weekly, and monthly quality MIS reports, dashboards, and scorecards to the Associate Manager
• Maintain up-to-date audit logs, error trackers, feedback sheets, and calibration records
• Generate team-level performance reports highlighting accuracy rates, defect trends, rework rates, and SLA adherence
• Document all audit findings with evidence and maintain an organized, audit-ready file system

Process Improvement

• Identify opportunities for process standardization, defect reduction, and workflow optimization within the QA function
• Participate in Lean / Six Sigma driven improvement initiatives and contribute to CI project execution
• Collaborate with operations and IT teams to pilot quality improvement technologies (e.g., AI-powered auditing tools, automation)
• Benchmark internal quality practices against industry standards and recommend improvements to the Associate Manager

Client & Stakeholder Interaction

• Support the Associate Manager in preparing quality summary reports, audit findings, and action plans for client quality calls
• Participate in client quality review meetings and present team-level quality metrics and trends
• Respond to client quality queries with data-backed insights and corrective timelines
• Maintain client-facing quality scorecards and ensure timely submission per contractual timelines

Education & Experience

• Graduate in any discipline; Healthcare Management, Life Sciences, or Medical Coding certification preferrable
• 7–8 years of total experience in RCM operations with a minimum of 4 years in a Quality Auditor / Senior QA role
• At least 2 years of proven experience in a team-handling or supervisory capacity within an RCM / healthcare BPO-KPO environment
• Hands-on experience in auditing across multiple RCM verticals (billing, AR, denials, payment posting)

Certifications

• CPC, CRC, CPMA, CCS, RHIT, or equivalent coding/billing certification preferrable.
• Six Sigma Green Belt or equivalent process improvement certification is a strong plus
• Certification required within 12 months of joining if not already held

Domain Expertise

• In-depth knowledge of ICD-10-CM, CPT, HCPCS Level II; familiarity with NCCI edits and LCD/NCD guidelines
• Strong understanding of Billing, Payment Posting, AR follow-up, Denial Management, and payer-specific rules
• Thorough knowledge of HIPAA, PHI, CMS guidelines, and patient data privacy requirements
• Experience with EMR/PMS systems and proficiency in QA dashboards and reporting tools
• Advanced proficiency in MS Excel (pivot tables, VLOOKUP, data analysis) and MIS/dashboard reporting

Leadership & Soft Skills

• Demonstrated ability to lead, coach, and develop quality teams with measurable performance improvement outcomes
• Excellent written and verbal communication skills for client interactions, presentations, and internal reporting
• Strong analytical thinking, problem-solving ability, and exceptional attention to detail
• Effective feedback delivery, conflict resolution, and stakeholder management skills
• Ability to manage multiple priorities, meet tight deadlines, and thrive in a fast-paced environment
• Knowledge of Lean / Six Sigma methodologies and continuous improvement frameworks

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish. 

• Quarterly Company-Wide Recharge Days

• Peer-based incentive “Cheer” awards

• Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/ 

https://veradigm.com/about-veradigm/careers/culture/ 

#LI-SL1

Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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