Role OverviewThe Claims Quality Assurance Analyst is responsible for monitoring and documenting production quality in support of departmental goals and initiatives, with a primary focus on claims auditing and claims-related interactions within the Revenue Cycle Management (RCM) function.
What You Will Do
The Analyst reviews claim audit results and claim transactions, evaluates verbal and written contacts, and ensures accuracy, completeness, proper documentation, and compliance with policies, procedures, and applicable regulations.
Why It Might Be a Fit
The ideal candidate has prior healthcare claims auditing experience, working knowledge of claims billing practices and state billing requirements, and a desire to emerge as a leader within the Operations team.
Requirements
- Minimum of 1 year of claims auditing experience supporting commercial, Medicaid, and Medicare lines of business, including working knowledge of billing rules and state/payer-specific requirements
- Working knowledge of Revenue Cycle Management (RCM) workflows and downstream impacts
- Consistent track record of 95% + in Quality and Production scores
- Proficient understanding of QA methodologies and quality monitoring practices
- Ability to analyze data to identify root causes of quality issues and propose actionable solutions
- Excellent communication skills
- Ability to coach/motivate employees with tact in order to facilitate optimal performance
- Maintain confidential information and abide by necessary rules and regulations
- Strong organizational, problem-solving, and analytical skills
- Proficiency in Word, Excel, and PowerPoint
Benefits
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO)
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
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