Claims Quality Assurance Analyst

Job Summary

Focused on claims auditing and quality monitoring, the full-time remote Claims Quality Assurance Analyst will evaluate claim transactions and interactions within the Revenue Cycle Management function, ensuring compliance and accuracy while supporting continuous improvement initiatives.

Key responsibilities

• Monitor claims quality and audit functions, providing support for other operational departments as needed
• Conduct claims audit reviews to ensure accuracy, required documentation, and compliance with policies and regulations
• Analyze audit findings and communicate actionable insights to leadership to drive improvements in operational processes

Required qualifications

• Minimum of 1 year of claims auditing experience with knowledge of billing rules and state/payer-specific requirements; DME experience preferred
• Working knowledge of Revenue Cycle Management workflows and their downstream impacts across various lines of business
• Consistent track record of achieving 95%+ in Quality and Production scores in previous roles
• Proficient understanding of QA methodologies and quality monitoring practices
• Bachelor's Degree preferred or equivalent experience