QA Specialist III - Client Success
New
J
JobgetherHealthcare Technology
United StatesFull-TimeSenior
Salary not disclosed
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Job Details
- Required Skills
- Data AnalysisQuality AssuranceProcess improvement
Requirements
- Bachelor’s degree in business, healthcare, or a related field; equivalent healthcare industry experience may be considered.
- Demonstrated experience in healthcare operations, payment integrity, overpayment recovery, or related fields.
- Strong understanding of overpayment recovery services and healthcare payer requirements.
- Excellent analytical skills with the ability to evaluate complex information and identify trends or risks.
- Strong communication and interpersonal skills, with the ability to collaborate effectively with clients, leadership, and peers.
- Ability to quickly learn new processes, make an immediate impact, and deliver value-driven solutions.
- Strong attention to detail and commitment to accuracy.
- Ability to manage priorities and perform effectively under tight deadlines.
- Team-oriented mindset with a desire to contribute to organizational growth and continuous improvement.
Responsibilities
- Perform advanced quality assurance reviews of highly complex overpayment accounts, applying payer requirements, client-specific guidelines, and quality assurance methodologies.
- Analyze overpayment determinations, calculations, and supporting documentation to ensure accuracy, compliance, and alignment with established quality standards.
- Serve as a subject matter expert for quality review scenarios, payer requirements, and client-specific processes.
- Identify recurring quality trends, operational risks, and process gaps while recommending improvements to increase efficiency and consistency.
- Support onboarding, coaching, and knowledge sharing activities for new team members by providing guidance and best practices.
- Participate in new client implementations by collaborating with operational leadership, implementation teams, client success teams, and other stakeholders.
- Help establish, refine, and maintain quality assurance requirements, methodologies, documentation, and review processes for new and existing clients.
- Analyze client communications and implementation discussions to incorporate evolving requirements into quality standards and operational workflows.
- Communicate potential risks, ambiguities, and process gaps while ensuring appropriate clarification and resolution.
- Maintain up-to-date knowledge of payer guidelines, client expectations, and industry practices through continuous learning and professional development.
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