RCM Process & Quality Analyst Lead

About this role:

Our work environment is fast-paced and collaborative, driven by a passion for delivering innovations that improve the quality of health care and patient experience. We are looking for like-minded individuals to join our team today!

Job Description:

At iRhythm, we are redefining how cardiac care is delivered through innovative technology and data-driven insights. Our mission is to improve patient outcomes and transform the healthcare experience. We're looking for an experienced RCM Process & Quality Analyst Lead to join our team and support operational excellence across our end-to-end revenue cycle (order to cash), with a focus on improving processes, quality, and consistency.

Reporting to the Manager, Revenue Cycle, the RCM Process & Quality Analyst Lead will be responsible for supporting the audit approach and execution of the end-to-end quality program, with a focus on improving consistency, compliance, and operational performance across the revenue cycle. This role leads audit activities, including escalation and resolution, within established compliance and control frameworks. The Lead partners with Internal Audit, Compliance, and cross-functional stakeholders to support alignment with regulatory requirements, payer expectations, and organizational standards. In addition, this role drives process improvements, supports cross-functional projects, and applies strong judgment across RCM processes and controls to maintain compliance and enable continuous improvement.

What You Will Be Doing:

• Lead the design, execution, and continuous improvement of the RCM audit approach, setting priorities aligned with enterprise risk, compliance requirements, and operational needs.

• Own end-to-end accountability for quality program effectiveness, including audit outcomes, compliance adherence, and performance improvements.

• Establish and oversee internal and vendor-facing audit programs, identifying systemic trends, control gaps, and improvement opportunities.

• Lead and govern call quality and performance review programs, ensuring consistency, accuracy, and alignment with organizational standards.

• Develop, standardize, and oversee RCM scorecards, KPIs, and performance frameworks to support data-informed decision-making.

• Lead in the design, implementation and continuous improvement of the SOX control environment, ensuring integrity of the control framework and successful audit outcomes.

• Own SOX compliance activities, including control design, execution oversight, issue identification, remediation planning, and sustained compliance validation.

• Serve as a primary point of contact for Internal Audit and Compliance, managing audit readiness, findings, and remediation efforts.

• Lead governance of payer portal access controls, offshore restrictions, and contractual compliance requirements through structured review processes.

• Partner cross-functionally with Market Access, Quality, Legal, Compliance, Finance, and Operations to resolve complex issues and ensure alignment with compliance requirements.

• Oversee payer contract validation and system configurations, ensuring accuracy across platforms such as Salesforce, ZIO Suite, and vendor systems

• Own and lead process improvement initiatives, defining future-state workflows that enhance efficiency, scalability, and compliance.

• Lead the development, governance, and continuous improvement of controlled documentation (SOPs, Work Instructions, Quality Control Documents).

• Provide mentorship, and performance oversight to analysts, establishing quality standards and fostering a culture of accountability and excellence.

• Resolve high-impact escalations from field sales, commercial leadership, and external partners with sound judgment and authority.

• Support cross-functional initiatives and special projects across RCM QA, compliance, and operational transformation.

• Perform additional duties as assigned to support departmental and organizational goals.

What We Need to See:

• 5+ years of experience in healthcare revenue cycle or related operational functions, with a focus on quality assurance, audit strategy, and process governance.

• Demonstrated experience leading enterprise-level audit programs and compliance initiatives, with accountability for outcomes.

• Strong understanding of LCDs/NCDs, payer contracts, claims adjudication, denial codes, and reimbursement workflows.

• Demonstrated expertise in SOX compliance within medical billing, including control design, execution, and governance.

• Proven success in leading cross-functional initiatives, influencing stakeholders, and driving organizational change.

• Experience interfacing with Internal Audit, Compliance, or external auditors, including ownership of audit outcomes and remediation efforts.

Skills:

• Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, macros, etc.).

• Experience with CRM systems, especially Salesforce.

• Strong analytical mindset with the ability to identify patterns, risks, and strategic opportunities in audit data.

Exceptional communication and executive-level stakeholder management skills.

• High degree of independent judgment, accountability, and decision-making authority.

• Ability to lead in a fast-paced, dynamic, and highly collaborative environment.

Education and Certifications:

• Bachelor's degree in Healthcare Administration, Health Information Management, Business Administration, Finance, or a related field; or equivalent work experience. Master's degree (MBA, MHA, MPH or similar) preferred.

• Relevant certifications highly desirable:Certified Revenue Cycle Representative (CRCR), Certified Professional in Healthcare Quality (CPHQ), Lean Six Sigma Green/Black Belt, Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)

Ways to Stand Out:

• Ability to navigate complex payer landscapes and networks.

• Demonstrated experience owning SOX control frameworks and audit strategy at scale.

• Proven ability to drive enterprise-level compliance and operational performance improvements.