Quality Manager

Objective: Hire a Quality Manager to elevate benefit verification, collections, cash posting, claims inspection, payments, data management and patient enrollment. The candidate will lead In-Process Quality, CAPAs, Complaints, and cross-functional improvements to improve operations. Must have strong healthcare experience (medical device preferred), including working with patients, customers, and payers.

Role Summary

The Quality Manager – Revenue Cycle lead In-Process Quality, Analytics, CAPAs, Complaints, and cross-functional improvements to improve operations. This position is responsible for establishing and maintaining quality assurance programs, policies, processes, procedures and controls ensuring that performance and quality of processes conform to established standards and agency regulation.

This role will govern quality standards, conduct root cause analyses on systematic issues, including process errors, build feedback loops with Operations, Customer Service, Supply Chain, Compliance, and IT, and drive corrective and preventive actions (CAPA) to improve operations. The ideal candidate brings above-average knowledge of the healthcare industry, preferably experienced in working with medical device programs, and the ability to translate data into actionable strategies for stakeholders.

Key Responsibilities

Quality & Governance

• Co-lead the Quality Management framework for Operations (In-Process Quality. Document Control, CAPA, Complaints and Training).

• Define, document, and maintain SOPs, quality checklists, audit plans, and control points across operations.

• Establish and monitor quality gates for internal processes.

• Ensure compliance of services to quality and industry standards.

Operations & Analytics

• Lead root cause analysis (RCA) for defects (e.g., data entry errors, eligibility mis-verification, claim denials, mis-posted cash, benefit misinterpretation), and drive CAPA.

• Build dashboards and perform deep-dive analyses (trends analysis, Pareto, control charts) to surface drivers of defects and prioritize process changes.

• Partner with team leads to implement first-time-right data capture in verification and enrollment; standardize scripts and process workflows.

• Oversee in-process quality to improve operation processes and reduce rework.

• Coordinate with Payments/Cash Posting to reconcile remits and ensure accurate posting and timely handling

Cross-Functional Leadership

• Work closely with Operations, Compliance, Finance, Document Control, Complaints, CAPA, Patient Support/Enrollment, IT/BEx, and Training to address findings and implement scalable process improvements.

• Provide strategy and guidance for workflows, escalation paths, and documentation standards.

• Run quality reviews with stakeholders; present insights and prioritize a quarterly improvement roadmap.

• Design and implement long-term solutions to improve service quality and customer experience.

Document Control and Training

• Manage document change control for policies, procedures, work instructions, job aids and patient letters.

• Lead document reviews, resolve cross functional discrepancies, and support new products/projects affecting Quality Systems.

• Develop and deliver targeted training on operations, compliance and quality system best practices.

• Coach supervisors and QA analysts on consistent scoring, calibration, and feedback delivery.

CAPA and Complaints

• Accountable for leadership and oversight of the CAPA system, and associated deliverables.

• Provide guidance, insight and training to the team and the wider business around CAPA process, quality standards, and regulatory requirements.

• Lead and/or contribute to continuous improvement initiatives and projects.

• Represent CAPA QA in cross functional meetings (site and division).

• Maintain and update Standard Operating Procedures (SOPs) for Complaint Management, deliver training on changes, and liaise with the Global Complaints Team.

• Monitor and report complaint trends and improvement outcomes to leadership.

Risk & Compliance

• Monitor adherence to HIPAA and payer-specific compliance standards; coordinate internal audits.

• Maintain documentation to support internal/external audits and CAPA tracking.

• Provide subject matter expertise during audits and inspections.

Required Qualifications

• 5–8+ years of experience in Healthcare Operations with at least 3 years focused on quality/QA, process excellence, or analytics.

• USRN/PHRN with 3-5 years clinical experience

• (Preferable) Experience in medical device processes.

• (Preferable) Strong knowledge of revenue cycle management.

• Demonstrated capability in root cause analysis and CAPA with measurable outcomes.

• Excellent stakeholder management, written and verbal communication, and the ability to build trust with frontline teams and leadership.