Claims Quality Assurance Analyst
New
V
Vaya HealthHealthcare Administration
United States, 8:30am-5:00pm (EST)Full-TimeMiddle
Salary42,872.55 - 55,734.32 USD per year
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Job Details
- Experience
- High School Diploma or GED with at least 5 years of experience; or Associate Degree with 2 years of post-degree experience.
- Required Skills
- Data AnalysisSharePointMicrosoft ExcelQuality Assurance
Requirements
- High School Diploma or GED with at least 5 years of health care claim processing experience (Medicaid, Medicare, 3rd party).
- Alternatively, an Associate Degree in a related field with at least 2 years of post-degree health care claim processing experience.
- Proficiency in Microsoft Word, Excel, Outlook, and SharePoint.
- Ability to learn claims adjudication systems and NC Tracks.
- Understanding of health insurance industry and healthcare data analysis.
- Knowledge of claims adjudication processes, provider contracting, and credentialing.
- Strong attention to detail and data accuracy.
- Effective verbal and written communication skills.
- Strong time management and independent decision-making skills.
- Ability to work independently and within a team to meet deadlines.
Responsibilities
- Audit a random sample of work performed by claim and enrollment specialists on a weekly basis.
- Evaluate staff understanding of processes and adherence to standard operating procedures.
- Document quality reviews in detail by work type and functional area.
- Provide timely feedback to managers and department leaders regarding audit findings.
- Prepare audit reports and serve as a subject matter expert for quality audit questions.
- Recommend new or modified processes to address processing accuracy errors.
- Collaborate with business partners to identify procedure gaps and system deficiencies.
- Support new employee onboarding by providing coaching and training assistance.
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