Quality Control Analyst

Job Summary

A company is looking for a Quality Control Analyst - Remote.

Key Responsibilities

• Audit claims for accuracy, including complex and high dollar claims, and review dispute requests from providers
• Identify system configuration issues affecting claims processing and communicate with relevant internal departments
• Create detailed audit findings and recommendations, and conduct retrospective audits of paid claims

Required Qualifications

• High school diploma or equivalent required; Bachelor's degree in Finance or Accounting preferred
• 5 years of experience as a Quality Control Analyst
• 2-3 years of experience as a Claims Adjuster
• Strong knowledge of Managed Healthcare and coding regulations (CPT, RBRVS, DRG, HCPCS, ICD-9, ICD-10)
• No certification required