Quality Manager - US Healthcare (RCM) Operations
About the Employer
Job Description
Quality Manager US Healthcare (RCM) Operations
- Location: Sri Lanka
- Work Arrangement: Sri Lanka Hybrid (Minimum 3 Days/Week in Office)
- Work Hours: 2:00 PM - 11:00 PM (Straddle shift)
- Department: Quality Assurance
- Function: RCM Operations
- Employment Type: Full-time
Shape the future of a high-growth healthcare-tech company
HealthRecon Connect is a technology-enabled healthcare Revenue Cycle Management (RCM) partner to US healthcare providers, with delivery operations spanning Sri Lanka, India and the Philippines.
We are looking for an experienced and forward-thinking Manager – Quality Assurance to lead our QA function within US Healthcare Revenue Cycle Management operations.
This role goes beyond traditional audit and quality checks. The selected candidate will be responsible for building a strong, insight-led QA function that supports operational excellence, reduces errors and rework, improves denial prevention, strengthens compliance, and drives continuous improvement across RCM processes.
Key Responsibilities
- Designing, implementing, and continuously improving the QA framework across RCM processes such as Billing, Coding, AR Follow-Up, Denials, Payment Posting, and related areas.
- Developing risk-based audit and sampling approaches that focus on high-impact areas.
- Establishing quality governance practices including calibration, error taxonomy, root-cause analysis, CAPA tracking, and trend reporting.
- Partnering with Operations leaders to identify recurring quality issues and drive corrective and preventive actions.
- Leading continuous improvement initiatives using Lean, Six Sigma, or similar methodologies.
- Building QA dashboards and reporting mechanisms that provide clear, actionable insights to internal and client stakeholders.
- Identifying opportunities to automate repetitive QA activities and supporting AI/automation initiatives within the quality function.
- Leading, coaching, and developing QA analysts and auditors to build strong technical capability and accountability.
- Supporting client governance discussions, business reviews, and quality-related stakeholder updates where required.
Key Requirements
- 8–10 years of experience in the US Healthcare RCM industry.
- Minimum 4–5 years of experience in QA, quality audit, or quality assurance within RCM.
- At least 3 years of experience leading a QA team.
- Strong hands-on knowledge across multiple RCM areas such as Medical Billing, AR Management, Denial Management, Medical Coding, and Payment Posting.
- Good understanding of US payer processes, claim adjudication, denial taxonomy, remittance processing, and payer requirements.
- Knowledge of HIPAA, CMS guidelines, and payer-specific compliance requirements.
- Experience in QA methodologies, audit design, sampling, RCA, CAPA, and quality governance.
- Strong analytical skills with working knowledge of Excel, Power BI, Tableau, or similar reporting tools.
- Exposure to automation, RPA, AI tools, or technology-enabled quality solutions will be an added advantage.
- Excellent communication, stakeholder management, and presentation skills.
- Ability to work in a fast-paced, high-volume environment while maintaining accuracy and quality standards.
Qualifications and Certifications
- Bachelor's degree in Healthcare Management, Business Administration, or a related field is preferred.
- CPC, CCS, CRCP, or similar RCM-related certification will be an advantage.
- Lean Six Sigma Green Belt or above will be a strong advantage.
- Certification or training in automation or AI tools related to healthcare/BPO operations will be an added advantage.
Who We Are Looking For
We are looking for a quality leader who can think strategically, lead teams with accountability, and use data to drive meaningful improvement. The ideal candidate should be comfortable working with senior stakeholders, challenging existing processes, and helping transform QA into a proactive quality intelligence function.
Why HealthRecon Connect
You will join a fast-growing, multi-geography organisation where you will have the opportunity to make a meaningful impact, contribute to our continued growth, and help shape how we work. We operate a hybrid model with a minimum of 3 days a week in our Colombo office, balancing in-person collaboration with flexibility.
Ready to apply?
- Apply via www.healthreconconnect.com/careers/ by selecting the relevant vacancy and clicking Apply Now.
- Applications without a CV will NOT be considered.
- Please review the workweek, shift details, and other job requirements carefully before applying.
- Due to the high volume of applications, only shortlisted candidates will be contacted. We appreciate your understanding.
HealthRecon Connect is an equal-opportunity employer. We celebrate diversity and are committed to an inclusive workplace.
