Associate Director Quality

Associate Director - Quality (RCM)(15+yrs)

Prochant is seeking a highly experienced RCM leader to oversee complete revenue cycle operations across intake, eligibility verification, prior authorization, billing, and accounts receivable. This senior leadership role will ensure seamless patient onboarding, payer compliance, claim accuracy, and denial prevention across the full RCM continuum.

Job Summary

The Associate Director – Quality is responsible for leading the quality strategy, governance, and continuous improvement initiatives across healthcare Revenue Cycle Management (RCM) operations. This role ensures compliance with client requirements, regulatory standards, and organizational quality objectives while driving operational excellence, process standardization, and performance improvement across functions such as Medical Billing, Accounts Receivable (AR), Denial Management, Payment Posting, Eligibility Verification, Prior Authorization, and Medical Coding.

Key Responsibilities

Quality Leadership & Governance

• Develop and execute the quality management framework for RCM operations.
• Establish quality goals, KPIs, and performance metrics aligned with organizational objectives.
• Lead quality governance reviews with senior leadership and client stakeholders.
• Drive a culture of quality, accountability, and continuous improvement across teams.

Process Excellence & Continuous Improvement

• Identify process gaps, root causes, and opportunities for operational improvement.
• Lead Lean Six Sigma, quality improvement, and transformation initiatives.
• Implement corrective and preventive action (CAPA) plans to improve quality performance.
• Drive standardization of processes, SOPs, and best practices across accounts and business units.

Quality Monitoring & Audits

• Oversee quality audits, transaction monitoring, calibration sessions, and compliance reviews.
• Ensure consistent application of quality standards across all RCM functions.
• Analyze audit findings, trends, and error patterns to develop improvement strategies.
• Conduct periodic internal and external quality reviews to maintain service excellence.

Client & Stakeholder Management

• Serve as a key quality partner for clients and internal stakeholders.
• Present quality performance reports, insights, and improvement plans during business reviews.
• Manage client escalations related to quality and ensure timely resolution.
• Build strong relationships with operations, training, compliance, and client teams.

Data Analytics & Reporting

• Develop quality dashboards and scorecards to track performance.
• Analyze operational and quality data to identify trends and improvement opportunities.
• Provide actionable recommendations to improve accuracy, productivity, and customer satisfaction.
• Leverage data-driven decision-making to support business objectives.

Training & Capability Development

• Collaborate with training teams to design and implement quality-focused learning programs.
• Mentor and develop Quality Managers, Team Leads, and Analysts.
• Conduct quality calibration sessions and knowledge-sharing initiatives.
• Build organizational capability in quality methodologies and continuous improvement practices.

Compliance & Risk Management

• Ensure adherence to healthcare industry regulations, client guidelines, and organizational policies.
• Support compliance with HIPAA, information security, and data privacy requirements.
• Identify quality risks and implement mitigation strategies.
• Participate in internal and external audits as required.

Experience

• 12–15+ years of experience in Healthcare Revenue Cycle Management (RCM), BPO, or healthcare operations.
• Minimum 5+ years of leadership experience in Quality, Process Excellence, or Operational Excellence.
• Strong experience across Medical Billing, AR Follow-up, Denial Management, Payment Posting, Eligibility Verification, and Medical Coding.
• Proven track record of leading large-scale quality transformation and process improvement initiatives.

Please contact Harini P - or