RCM Quality Assurance Specialist
Accountabilities: As an RCM Quality Assurance Specialist , you will be responsible for auditing revenue cycle management activities, identifying improvement opportunities, and supporting teams in maintaining high standards of accuracy and compliance. You will collaborate with management and operational teams to improve processes, resolve issues, and enhance overall performance.
Perform daily audits of RCM accounts to ensure accuracy and compliance with established quality policies and procedures.
Review documentation, billing records, and account activity to identify errors, missing information, and process gaps.
Maintain detailed records of quality findings and prepare monthly summary reports for management review.
Communicate quality issues and provide constructive feedback to staff and department leaders.
Identify recurring errors, trends, and deficiencies to support process improvements and training initiatives.
Collaborate with department leadership to review workflows, optimize procedures, and improve operational efficiency.
Support employee training activities by providing QA insights, guidance, and feedback.
Monitor trends related to missing documentation, denials, payer issues, system challenges, and other key RCM performance indicators.
Escalate potential operational, system, or staff-related issues to appropriate leadership teams.
Respond to inquiries from internal departments and provide quality-related support.
Ensure compliance with information security policies, procedures, and mandatory training requirements.
Maintain professionalism and adherence to organizational policies, ethical standards, and compliance expectations.
Requirements:
The ideal candidate has experience in revenue cycle management quality assurance, healthcare billing processes, and operational auditing. Strong attention to detail, analytical skills, and the ability to communicate findings effectively are essential for success in this role.
High School diploma or GED required.
Associate degree in Health Information Technology (RHIT) or related field preferred.
5+ years of experience in RCM quality assurance auditing, training, or a related healthcare revenue cycle role preferred.
Strong understanding of RCM billing systems and healthcare revenue cycle processes.
Experience reviewing documentation, identifying discrepancies, and analyzing quality trends.
Strong computer skills, including the ability to navigate multiple systems and screens efficiently.
Excellent attention to detail and ability to identify process improvement opportunities.
Strong communication skills with the ability to provide clear feedback and collaborate with different teams.
Ability to work independently, manage priorities, and maintain accuracy in a remote environment.
Benefits:
Remote work opportunity with flexibility.
Competitive compensation package.
Medical, dental, and vision insurance options.
Life and disability insurance coverage.
Healthcare Flexible Spending Account (FSA) and Dependent Care FSA options.
Limited Healthcare FSA, transportation, parking benefits, and Health Savings Account (HSA) options.
401(k) retirement plan with company matching contributions.
Paid Time Off (PTO), including up to 9 observed holidays and paid family leave.
Professional development, training opportunities, and career growth support.
Inclusive workplace culture focused on integrity, teamwork, and continuous improvement.
How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether?
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