Quality Analyst - Accounts Receivable Voice Process in Revenue Cycle Management

Overview

Join Guidehouse, a global consulting leader providing management, technology, and risk consulting services to public and commercial sectors. Guidehouse India supports the firm's growth in managed services and digital transformation, emphasizing a culture that values diversity and belonging across its offices including Hyderabad.

Key Responsibilities

• Execute quality audits on inpatient and observation accounts focusing on Notification on Admission (NOA) compliance following sampling guidelines.
• Ensure accuracy and completeness of notifications submitted via portals, EDI, fax, or calls, and timely non-clinical authorization initiation.
• Verify documentation details such as authorization numbers, reference IDs, payer timeframes, and adherence to compliance standards.
• Analyze root causes of defects identified in audits, develop corrective and preventive action plans (CAPA), and monitor trends related to missed NOAs, delays, and documentation errors.
• Deliver actionable feedback based on audit results, clarify process ambiguities, lead improvement discussions, and engage in regular performance review meetings.
• Compile and maintain quality reports daily, weekly, and monthly; monitor service level agreements (SLA) and accuracy metrics; participate in governance reviews.
• Attend calibration sessions, refresher trainings, and continuous learning initiatives to uphold process quality standards.

Candidate Profile

• Minimum of 3 years’ experience in US Healthcare Revenue Cycle Management (RCM).
• Comprehensive understanding of Authorization and Notification on Admission (NOA) processes with practical experience.
• Excellent analytical skills with attention to detail and problem-solving capabilities.
• Effective communicator able to provide clear and constructive feedback.
• Previous experience in a Quality Assurance or Auditor role is essential.
• Availability to work night shifts.
• Must hold an undergraduate degree (diploma holders are not eligible).
• Applicants must provide recent employment documentation proofs.

Preferred Qualifications

• Experience in quality assurance or audits within US Healthcare RCM.
• Exposure across various RCM functions such as Accounts Receivable, Denials, Charge Entry, and Payment Posting.
• Proficient in trend analysis, interpreting data, and generating quality reports.
• Familiarity with audit tools, scorecards, and quality measurement metrics.
• Knowledge of HIPAA regulations and quality compliance standards.
• Capability to mentor and support team performance enhancement.

Additional Information

Worksite is located at Guidehouse India Pvt Ltd, WeWork Raheja Mindspace, Mindspace Cyberabad, Hyderabad. Employees must use provided cab services and should reside within a 25 km radius of the office, as cab availability depends on feasibility.