RCM Claims QA Supervisor

Eye Care Partners Career Opportunities; Clifton (TX); On-site; USD 85,000 - 120,000; Full time

Job summary

EyeCare Partners seeks a Quality Assurance Supervisor- Claims to oversee charge posting and claims QA for multiple practices and offshore resources. You will lead QA auditing, training, and data-driven improvements to ensure accuracy and regulatory compliance.

The role requires 3+ years in claims QA, supervisory experience, and strong CPT/ICD-10 knowledge, with advanced Excel and PowerBI skills. Based in the U.S. with state license requirements for 18 eligible states.

Qualifications

• 3+ years in charge posting or claims submission and reconciliation.
• Supervisory/QA experience preferred (1-2 years).
• Strong CPT/ICD-10 understanding and claims workflows.
• Experience with billing platforms and clearinghouses.
• HIPAA and regulatory compliance knowledge.

Responsibilities

• Supervise day-to-day operations of charge posting and claims readiness teams across internal and offshore resources.
• Review and audit claims submissions, edits, clearinghouse rejections, and charge entry for quality, accuracy, and timely processing.
• Perform routine QA audits with an initial 10–15% sample rate, logging errors such as CPT/ICD-10 mismatches, modifier issues, and payer submission inaccuracies.
• Track, analyze, and report trends in errors, edits, and rejections; provide monthly QA and performance summaries to leadership.
• Use PowerBI and other reporting tools to create dashboards with site-specific and functional QA metrics.
• Coordinate with managers to address systemic training issues, identify process gaps, and implement improvements.
• Participate in weekly syncs with management to align QA findings with training strategy and offshore coaching plans.
• Maintain and update QA procedures, SOPs, and documentation aligned with current billing guidelines.
• Resolve complex or escalated claims and charge issues, ensuring accurate documentation and communication.
• Conduct training for teams on billing protocols, charge entry standards, and regulatory updates.
• Ensure compliance with HIPAA and all federal/state billing regulations.
• Encourage cross-functional communication and support the transition to a more standardized and functional model across RCM.
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.

Skills

CPT/ICD-10 coding

QA analytics

Excel proficiency

Communication skills

Problem solving

Team leadership

HIPAA knowledge

Tools

NextGen

Waystar

Job description

EyeCare Partners seeks a Quality Assurance Supervisor- Claims to oversee charge posting and claims QA for multiple practices and offshore resources. You will lead QA auditing, training, and data-driven improvements to ensure accuracy and regulatory compliance.

The role requires 3+ years in claims QA, supervisory experience, and strong CPT/ICD-10 knowledge, with advanced Excel and PowerBI skills. Based in the U.S. with state license requirements for 18 eligible states.