Healthcare Claims Quality Analyst

Job Summary

Focused on claims auditing and quality assurance, the full-time Healthcare Claims Quality Analyst will monitor production quality, evaluate claims transactions, and support Revenue Cycle Management initiatives in a remote work environment.

Key responsibilities

• Monitor claims quality and audit functions, including conducting claims audit reviews for accuracy and compliance
• Support the design and maintenance of quality monitoring formats and standards, documenting findings and presenting insights to leadership
• Identify and trend audit findings to drive continuous improvement and collaborate with operations to reduce defects

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 commercial, Medicaid, and Medicare
• 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