RCM QA Specialist

Join the Team Modernizing Medicine

At ModMed, we’re not just building software—we’re reimagining the healthcare experience. Founded in 2010 by a practicing physician and a successful tech entrepreneur, we took a radically different approach: we hired doctors and taught them how to code. This "for doctors, by doctors" philosophy has allowed us to create an AI-enabled, specialty-specific cloud platform that places patients at the center of care.

A Culture of Excellence

When You Join ModMed, You’re Joining An Award-winning Team Recognized For Innovation And Employee Satisfaction. From Our Global Headquarters In Boca Raton Florida, And Extensive Employee Base In Hyderabad India, We Are a Team Of 4,500+ Passionate Problem-solvers On a Mission To Increase Medical Practice Success And Improve Patient Outcomes

• Consistently ranked as a Top Place to Work
• 2025 Globee Business Awards: Gold Globee for “Technology Team of the Year”
• 2025 Black Book Awards: Ranked #1 EHR in 11 Specialties
• Florida Venture Forum: Venture-Backed Company of the Year
  
  

We are growing fast, thinking big, and we are just getting started.

Ready to modernize medicine with us?

Job Description Summary

The RCM Quality Assurance (QA) Specialist will be responsible for auditing the work of RCM AR analysts to ensure the highest standards of services are delivered. They will play a pivotal role in identifying process gaps and work closely with onshore and offshore teams to define SOPs and decision trees that will improve the process.

Essential Duties And Responsibilities

• This role involves auditing for the ModMed team members, evaluating transactions to make sure they are error-free and compliant with the process & sharing feedback with the team.
• Participate in process & training calls as required Reports sharing to communicate performance effectively and timely with Ops and QA team
• Will be actively involved in creating audit & sample plan, feedback sharing & training the team members weekly, based on the themes identified. QA will be involved in weekly or biweekly calibration calls
• Work closely with the supervisors to develop agent & team level action plans for Quality improvement.
• Utilize tools and technologies available to ensure quality concerns are proactively identified and corrected.
• Work closely with operational teams to resolve process ambiguity by calibrating on audit process and parameters.
• Ensure Standard Operating Procedures (SOPs) and client-specific practice instructions are followed by the team members and report any gaps identified with recommendations for improvement.
• Continuously improve the quality processes by suggesting innovative ways quality concerns can be quickly identified, fixed and monitored to avoid recurrence.
• Actively monitor for compliance as per HIPAA guidelines and report any incidence of non-compliance.
• Actively participate in quality and training huddles, create content, and deliver the necessary training to resolve identified skill or knowledge gaps on the team.
• Audit for adherence to SOPs and other guidelines and provide references and feedback.
• Review customer feedback/concerns and ensure that corrective action is being taken, adhering to the plan of action.
• Provide feedback on SOPs so that the processes and procedures are created in such a way that these can be implemented most effectively.
• Based on audit findings ver and propose changes in decision trees to the Supervisors through which inefficiencies and redundancies can be eliminated.
• Provide training and guidance to team members to improve their knowledge and skills so they are sufficiently equipped to deliver best-in-class services.
• Collaborate with the onshore quality team to ensure consistency in processes and procedures being followed across Modmed locations.
• Perform additional projects and job duties as assigned.
  
  

Experience And Skills Requirements

• 5+ years of relevant working experience in core Provider RCM out of which minimum 2 years as SME, QA, QA Lead, etc. within a professional setting.
• Hands-on knowledge of the key functions within RCM is a must.
• Prior experience of working on Modmed products is a plus.
• Experience working on process improvements/ six sigma quality projects preferred.
• Proven knowledge of various insurance carriers, including Medicare, private HMOs, PPOs, Capitation and Workers’ Comp. etc.
• Advanced excel skills such as the ability to use formulas to analyze data, create and format pivot tables and templates, use and conditional formatting and validation functions, able to create visualizations of data through charts, graphs and powerpoint; able to manage information located in multiple software systems.
• Exceptional written, verbal, and interpersonal communication skills required.
• Committed to developing expertise in respective ModMed products (PM or gPM) within 3 months of employment.
• Professional demeanor, team player, strong time management skills required.
• Able to work during US night shifts within a hybrid work model from home and office is required - this position requires working closely with onshore/offshore teams, as well as with payer reps.
  
  

ModMed Benefits Highlight: At ModMed, we believe it’s important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:

• Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk,
• Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees,
• Allowances: Annual wellness allowance to support your well-being and productivity,
• Earned, casual, and sick leaves to maintain a healthy work-life balance,
• Bereavement leave for difficult times and extended medical leave options,
• Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave,
• Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind.
  
  

PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (first.lastname@modmed.com). Please check senders’ email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.

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