Quality Assurance Insurance Specialist

Bioventus; Memphis (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

Bioventus in Memphis seeks a Quality Assurance Insurance Specialist to support reimbursement strategies by handling payer audit requests and ensuring quality documentation. You will coordinate appeals, patient advocacy, and collaboration with billing and compliance teams.

The role requires 5–7 years in insurance compliance or medical claims, with strong communication and organizational skills. A background in medical devices or healthcare is preferred; attention to policy and denials trends is

Qualifications

• Must have strong communication and customer service skills.
• Excellent organizational and documentation abilities are required.
• Familiarity with Microsoft Office and quality management systems is expected.

Responsibilities

• Serves as patient advocate in the appeals process, gathers and compiles sufficient documentation to develop appeals case data for submission to review board.
• Arrange and prepare physicians for peer review
• Performs retrospective medical necessity reviews to determine appeals after denials have occurred.
• Monitor insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons.
• Identify coding or clinical documentation issues and work to correct the errors in a timely manner.
• Performs audit review of payer audit accounts and payer medical necessity denials while working closely with the management team on strategies to improve coding QA methods
• Works towards achieving individual and company goals for cash collections, payer audits, credit balances, medical records, correspondence, appeals/disputes, and accounts receivable over 90 days.
• Receives, documents, processes, and tracks payer audit requests until resolution.
• Assists the liaison between company and outsourced agency(s) focused on appeals processing.
• Conduct analysis on data collected during up front denials, review process, medical payor records and appeals decisions results.
• Holds oneself and others accountable to conduct business in a manner compliant with Bioventus’ Code of Compliance and Ethics, policies and procedures and internal controls applicable to their role.
• Other duties as assigned

Skills

Communication

Customer service

Organization

Documentation

Microsoft Office

Quality systems

Education

High School diploma or GED

Associates degree preferred

Tools

Microsoft Office Suite

Document control

Quality management systems

Job description

Are you ready to work for a more active world?

At Bioventus, our business depends on developing our people. We invest in you and challenge you to be the best. We value our colleagues for their different perspectives and individual contributions, and our leaders listen. Our success rests on working together to achieve shared goals and rewards. Join a diverse team of global colleagues driven to help patients resume and enjoy active lives.

The Quality Assurance Insurance Specialist will support the reimbursement strategy of the company by receiving and processing commercial and government payer audit requests, reviewing and organizing documentation, ensuring quality assurance, communicating with management regarding any issues or trends, prioritizing tasks assisting billing and compliance teams with payer policy or reimbursement audits while delivering excellent customer service. Will be responsible for coordinating all appeals processes

What you’ll be doing

• Serves as patient advocate in the appeals process, gathers and compiles sufficient documentation to develop appeals case data for submission to review board.
• Arrange and prepare physicians for peer review
• Performs retrospective medical necessity reviews to determine appeals after denials have occurred.
• Monitor insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons.
• Identify coding or clinical documentation issues and work to correct the errors in a timely manner.
• Performs audit review of payer audit accounts and payer medical necessity denials while working closely with the management team on strategies to improve coding QA methods
• Works towards achieving individual and company goals for cash collections, payer audits, credit balances, medical records, correspondence, appeals/disputes, and accounts receivable over 90 days.
• Receives, documents, processes, and tracks payer audit requests until resolution.
• Assists the liaison between company and outsourced agency(s) focused on appeals processing.
• Conduct analysis on data collected during up front denials, review process, medical payor records and appeals decisions results. Identify problem accounts and escalat as appropriate. Develops and produces reports based on data identified during analysis
• Holds oneself and others accountable to conduct business in a manner compliant with Bioventus’ Code of Compliance and Ethics, policies and procedures and internal controls applicable to their role.
• Other duties as assigned

What you’ll bring to the table

• High School diploma or GED required; Associates degree preferred
• Minimum 5–7 years of experience in insurance compliance, quality assurance, or medical claims within a highly regulated industry, preferably medical devices, healthcare, or pharmaceuticals.
• Knowledge of government program regulations, Medicare, and other third-party payors is required.
• Understanding of business service functions including billing, collection, insurance and appeals.
• Excellent communication and customer service skills.
• Ability to read/interpret medical records and medical policy guidelines
• Strong organizational and documentation skills with the ability to manage multiple competing priorities.
• Proficient in Microsoft Office Suite and document control or quality management systems

Are you the top talent we are looking for?

Bioventus is committed to fostering an inclusive and diverse community of employees with a strong sense of belonging. We believe we are bettered by all forms ofdiversity andtake pride in working with top talent from every walk of life. In the spirit of inclusivity, qualified applicants will be considered without regard to age, ethnicity, disability, gender, veteran status, gender expression, gender identity, nationality, race, religion or sexual orientation. All individuals, regardless of personal characteristics, are encouraged to apply.