RCM Team Lead/ RCM QA

Role & responsibilities

1. Operations Management

• Oversee day-to-day claims follow-up, denials resolution, and payment recovery activities.
• Monitor work queues, TAT compliance, and resolution rates to ensure SLA adherence.
• Allocate accounts, track workloads, and ensure even distribution of tasks among team members.
• Review claim notes and ensure complete, professional, and audit-ready documentation.

2. Performance & Quality Oversight

• Use the Performance Scorecard to track and report on team metrics:
• Productivity
• TAT compliance
• Resolution rate
• Quality and accuracy
• Idle/no-touch rate
• Conduct daily huddles and weekly performance reviews to improve output.
• Identify underperformers early and implement targeted coaching or retraining plans.
• Partner with QA team to ensure >98% quality compliance.

3. Client & Payer Communication

• Support escalations with U.S. payer representatives and client-side account managers.
• Review aging reports and collaborate with the clients billing and payment teams for faster recovery.
• Provide insights on payer trends, denials patterns, and cash flow improvement opportunities.

4. Team Leadership & Development

• Mentor, train, and guide AR executives on communication skills, denial handling, and compliance.
• Drive accountability and ownership through transparent goal-setting and incentive linkage.
• Support recruitment, onboarding, and continuous learning initiatives for new hires.
• Foster a positive work environment that encourages collaboration and recognition.

5. Reporting & Process Improvement

• Prepare daily, weekly, and monthly AR dashboards covering key metrics and variances.
• Work with Operations Head to design process improvement and automation initiatives.
• Participate in client calls, RCA discussions, and CAPA action planning.

Preferred candidate profile

For Team Lead:

• 6+ years of experience in U.S. Healthcare AR / VOB including at-least 2 years in a lead role.
• Strong knowledge of payer follow-up, denials management, and claim life cycle.
• Proven ability to analyse data and coach teams using metrics like TAT, productivity, accuracy, and recovery.
• Proficiency in Excel, Google Sheets, and workflow management tools.
• Excellent communication and analytical skills; client-interfacing experience preferred.

For QA :

- 5+ years of overall experience , with at-least 1 year in QA role auditing AR / VOB

• Strong knowledge of payer follow-up, denials management, and claim life cycle.
• Proven ability to analyse data and coach teams using metrics like TAT, productivity, accuracy, and recovery.
• Proficiency in Excel, Google Sheets, and workflow management tools.
• Excellent communication and analytical skills; client-interfacing experience preferred.