[Remote] Healthcare Claims Quality Analyst

Note: The job is a remote job and is open to candidates in USA. Integra Partners is a leading national durable medical equipment network administrator focused on improving healthcare access. The Claims Quality Assurance Analyst is responsible for monitoring and documenting production quality, primarily focusing on claims auditing and ensuring compliance with policies and regulations.

Responsibilities

• Primarily monitor Claims quality and audit functions, with support for other operational departments as business needs require; DME claims experience preferred
• Participate in and support the design of quality monitoring forms and quality standards
• Record evaluations utilizing departmental quality monitoring forms
• Conduct claims audit reviews to confirm claim accuracy, required documentation, workflow adherence, and compliance with internal policies and applicable requirements
• Evaluate claim handling for appropriate billing practices, including awareness of state-specific billing requirements as applicable to the claim type and line of business
• Support Revenue Cycle Management (RCM) quality outcomes by identifying audit findings that drive denials, rework, or reimbursement issues and partnering with operations to reduce defects
• Identify and trend audit findings (e.g., documentation deficiencies, timeliness, process gaps, billing errors) and communicate actionable insights to leadership and operations partners
• Collect, evaluate, report on and track operations data against performance metrics
• Prepare and analyze quality reports for Management review
• Prepare and facilitate quality calibration sessions with designated department leads · Facilitate meetings and prepare presentations related to insight analysis
• Collaborate with the leadership team to create content-based training that will equip operations personnel with the necessary skills for success
• Monitor trends and provide input or feedback on the information reported on
• Identify, analyze and share ways to optimize the quality monitoring process
• Complete all evaluations, reports and employee coaching sessions on a timely basis
• Ability to learn new systems, tools, and methodologies as needed and continue progressing in a dynamic environment
• Support ad hoc quality monitoring, reporting and analysis activities based on operational needs
• Work and communicate cross-departmentally

Skills

• Minimum of 1 year of claims auditing experience supporting commercial, Medicaid, and Medicare lines of business, including working knowledge of billing rules and state/payer-specific requirements; DME preferred. Other QA/production experience a plus (or equivalent education and experience)
• Working knowledge of Revenue Cycle Management (RCM) workflows and downstream impacts (e.g., clean claim submission, edits, denials, appeals, payment posting/reconciliation) across commercial, Medicaid, and Medicare
• Desire and capability to emerge as a leader within the Operations team
• Consistent track record of 95% + in Quality and Production scores in current/previous roles
• Proficient understanding of QA methodologies and quality monitoring practices
• Demonstrated ability to rapidly gain product, process and tools knowledge and effectively communicate it to employees
• Ability to analyze data to identify root causes of quality issues and propose actionable solutions
• Excellent communication skills including listening, interpersonal, verbal, written, spelling and grammar
• Ability to coach/motivate employees with tact in order to facilitate optimal performance
• Must exhibit leadership capabilities and interpersonal skills
• Maintain confidential information and abide by necessary rules and regulations
• Strong organizational, problem-solving, and analytical skills
• Manage conflicting priorities while clearly communicating and managing expectations
• Proficiency in Word, Excel and PowerPoint for presentations and reports
• Flexible and able to multitask and work with changing priorities with enthusiasm
• Self-motivated, detail-oriented and prepared to work independently or as an active team player
• Ability to remain focused and motivated during the auditing process
• DME claims experience
• Healthcare experience preferred
• Fluent in Spanish and English preferred
• Bachelor's Degree preferred or equivalent experience

Benefits

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities

Company Overview

Company H1B Sponsorship