Claims Quality Assurance Analyst

The 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. The Claims Quality Assurance Analyst reviews claim audit results and claim transactions, as well as evaluates both verbal and written contacts, to ensure accuracy, completeness, proper documentation, and compliance with policies, procedures, and applicable regulations.

The Analyst supports the design and maintenance of quality monitoring formats and standards, documents quality findings, and effectively presents results, feedback, and trend data to leadership to drive continuous improvement. The ideal candidate has prior healthcare claims auditing experience, working knowledge of claims billing practices and state billing requirements. DME claims experience is preferred.

While this role is primari...