Senior Quality Analyst RCM | US Healthcare

Location: Remote (India)

Experience: 5 to 10 years

Shift: 5:30 PM to 2:30 AM IST (aligned to US Eastern business hours)

Role Overview

We're looking for an experienced RCM Quality Analyst to own quality for our automation bots, healthcare applications, and RCM reporting. You'll make sure our bots and software handle RCM work accurately, the way an experienced biller or AR specialist would, and that the reports leadership relies on are correct. You'll audit and test outputs, identify errors, perform root cause analysis, and work with our technology team to fix issues before they reach production.

If you've worked as a Quality Analyst or QA Auditor in US Healthcare RCM, you already have the core skills for this role. We'll train you on our tools, testing standards, and automation processes. Experience with eClinicalWorks is a plus.

Key Responsibilities

Quality Audit and Testing

- Audit bot and application outputs across RCM processes such as eligibility verification, prior authorization, claim status, denial management, AR follow-up, and payment posting.
- Validate outputs against source data, including payer portals, EOBs/ERAs, and EMR records, using structured sampling that covers different payers and edge cases.
- Define expected outcomes and test scenarios for each automated process, including exceptions such as inactive coverage, missing authorizations, COB issues, and payer-specific variations.
- Perform functional (black-box) testing of application features and bots, including workflow, UI, and negative-scenario testing, using structured test cases.



Training on our testing standards and templates will be provided.
- Validate AI-generated outputs, such as coding suggestions, for accuracy.
- Run regression checks after bots or applications are updated, to confirm existing processes still work correctly.

Report and Data Validation

- Validate RCM reports and analytics (collections, denials, AR aging, patient volumes) against PM system source reports.
- Investigate discrepancies between reports, and document the reason when figures differ, such as different date bases, filters, or definitions.

Error Analysis and Reporting

- Perform root cause analysis (RCA) on errors and recurring issues, and recommend corrective actions to the technology team.
- Log clear defects that explain what went wrong, what the correct outcome should be, and the business impact.
- Track accuracy metrics, and prepare daily, weekly, and monthly quality reports.
- Provide go/no-go input before bots and updates are released to production, and support UAT with billing and operations users.
- Share quality findings and risks clearly with engineering and business leadership, and help set audit and testing standards as the team grows.

Required Skills

- 5+ years of US Healthcare RCM experience,



including at least 2 years in a Quality Analyst or QA Auditor role.
- Solid hands-on knowledge of RCM processes, especially eligibility verification, prior authorization, denial management, and AR follow-up.
- Solid understanding of CARC/RARC denial codes, EOBs/ERAs, claim rejections vs. denials, timely filing, and COB.
- Experience working with payer portals (e.g., Availity or payer-specific portals).
- Hands-on experience with at least one PM/EMR system (e.g., eClinicalWorks, athenahealth, NextGen, Epic, AdvancedMD).
- Experience working with PM/billing system reports (e.g., AR aging, collections, denial reports), and understanding how report definitions and date bases affect results.
- Experience with audit sampling, accuracy scoring, RCA, and quality reporting.
- Strong attention to detail and structured thinking.
- Strong Excel skills (filters, pivots, VLOOKUP/XLOOKUP) for analyzing audit and report data.
- Practical understanding of HIPAA and PHI handling.
- Clear written English for documenting findings, defects, and reports.

Nice to Have

- Experience with eClinicalWorks, including eBO reports (preferred).
- Software testing or UAT experience.
- SQL experience is a strong plus. Willingness to learn basic SQL for data validation is expected.
- Experience with RPA bots or automation projects.
- Knowledge of EDI transactions (837, 835, 270/271, 276/277).
- Knowledge of CPT, ICD-10, and modifiers; coding or auditing certification (CPC, CPMA) is a plus.
- Multi-specialty RCM experience.
- Experience with Jira or similar tracking tools.

📌 Senior Quality Analyst - RCM | US Healthcare (Delhi)
🏢 Verita Software
📍 Delhi