Associate Vice President Quality - US Healthcare RCM Medical Billing

Job Description

Job Title: AVP – Business Excellence, Quality
Work Location: India
Department/Vertical: Business Excellence – Quality
Reports To: VP & Head of Business Excellence

Shift: UK/US Shift Hours

Position Overview

The AVP – Business Excellence, Quality will provide strategic leadership and oversight for the organization’s healthcare quality audit function. The role will be responsible for developing and executing a comprehensive quality audit strategy aligned with organizational objectives, healthcare quality standards, regulatory requirements, and industry best practices.

Key Responsibilities

1. Strategic Leadership & Oversight

• Develop and implement a comprehensive quality audit strategy aligned with organizational goals, quality objectives, and applicable regulatory requirements.
• Provide strategic direction and leadership to the Quality Audit function, establishing clear objectives, performance measures, governance mechanisms, and accountability.
• Build, lead, mentor, and develop a high-performing team of quality audit professionals.
• Oversee the design, standardization, and continuous improvement of quality audit processes, methodologies, tools, and frameworks.
• Establish an effective audit governance model, including risk-based audit planning, prioritization, escalation, and reporting.
• Stay abreast of emerging healthcare quality trends, regulatory changes, accreditation standards, and industry best practices.
• Identify opportunities to leverage data, analytics, automation, and technology to enhance audit effectiveness and efficiency.

2. Quality Audit Management

• Manage a comprehensive portfolio of quality audits across relevant healthcare operations and functions.
• Develop risk-based annual and periodic audit plans, defining audit objectives, scope, timelines, resources, and expected outcomes.
• Prioritize audits based on business risk, quality performance, regulatory requirements, historical findings, and emerging areas of concern.
• Lead or oversee the execution of quality audits, ensuring consistency, objectivity, compliance, and adherence to established audit standards and procedures.
• Review and validate audit findings to ensure accuracy, relevance, and appropriate risk classification.
• Analyze audit results and trends to identify systemic issues, recurring deficiencies, process gaps, and root causes.
• Recommend and oversee corrective and preventive action plans to address identified quality issues.
• Establish mechanisms to track remediation activities and ensure timely and sustainable closure of audit findings.
• Conduct periodic reviews of audit effectiveness and continuously improve audit methodologies based on lessons learned and emerging risks.

3. Reporting, Analytics & Communication

• Prepare and review comprehensive audit reports highlighting key findings, risks, root causes, recommendations, and corrective action plans.
• Develop executive-level dashboards, scorecards, and reports to provide visibility into quality performance, audit outcomes, risk trends, and remediation status.
• Present audit findings, quality trends, risk themes, and improvement opportunities to senior leadership and relevant stakeholders.
• Ensure timely escalation of significant quality, compliance, or regulatory risks to appropriate leadership.
• Support responses and communications with regulatory or accreditation agencies, where applicable.
• Translate complex audit findings and quality data into actionable insights and business recommendations.

4. Stakeholder Management & Collaboration

• Build strong and collaborative relationships with internal stakeholders, including Clinical, Operations, Compliance, Risk, Legal, and other relevant functions.
• Partner with business leaders to drive effective implementation of corrective and preventive actions.
• Collaborate with clinical and operational teams to identify opportunities for process improvement and enhance the overall quality of care and services.
• Coordinate with external auditors, accreditation bodies, and regulatory agencies, where applicable.
• Act as a trusted advisor to senior leadership on healthcare quality, audit risk, regulatory readiness, and continuous improvement.
• Foster a culture of quality, accountability, transparency, and continuous improvement across the organization.

5. Quality Culture & Continuous Improvement

• Promote the value and importance of quality audits as a mechanism for risk management, operational excellence, and continuous improvement.
• Establish and reinforce a culture focused on quality, patient/customer outcomes, compliance, and sustainable process improvement.
• Identify opportunities to standardize best practices across functions, locations, and business units.
• Drive quality improvement initiatives based on audit insights and organizational priorities.
• Develop and deliver quality awareness and audit-readiness programs for relevant stakeholders.

Required Skills & Competencies

Qualifications & Experience

Education

• Master’s degree / Bachelor’s Degree , or a related field is preferred.

Experience

· 16+ years of experience in US healthcare RCM managing AR, Billing with current role in Quality or Operations

· Having experience in US healthcare RCM is mandate

· Should have strong Process and client-facing skills (strong delivery leader)

· Good knowledge of Lean and six sigma / Certification in Lean and other quality practices added advantage.

Department

Permanent

Open Positions

1

Skills Required

US Healthcare,Medical Billing,Accounts Receivable,PNL Management,People Management,Quality Management

Education/Qualification

Graduate

Desirable Skills

Us Healthcare,Medical billing,Accounts Receivable,PNL Management,People Management,Quality Management

Years Of Exp

16 to 22 years