Quality Assurance Representative II

Job Summary

To support the quality assurance efforts within managed care, the full-time Quality Assurance Representative II will conduct performance reviews and audits, analyze complex transactions, and provide feedback and recommendations to enhance customer service, all while working remotely.

Key responsibilities

• Conduct performance and quality reviews to ensure accuracy and completeness in service delivery
• Analyze complex transactions and identify problems related to customer needs and contract language
• Provide mentorship and technical guidance to team members while sharing insights and trends with leadership

Required qualifications

• High School Diploma or General Education Diploma (GED)
• At least 1 year of recent relevant experience in healthcare operations or medical billing
• Familiarity with various medical insurance types and basic medical terminology, including CPT and ICD-10 codes
• Proficiency in electronic health record systems and Microsoft Office Suite
• Demonstrated analytical and critical thinking skills with the ability to reconcile data differences