RCM/ OPH Quality Assurance Supervisor

Eye Care Partners Career Opportunities; Clayton (NC); Hybride; USD 70 000 - 90 000; Plein temps

Résumé du poste

EyeCare Partners is seeking aQuality Assurance Supervisor- Claims to oversee QA across charge entry and claims management for multiple practices. This role supervises internal teams and coordinates with offshore staff, driving QA auditing, workflow optimization, and standardization to meet payer guidelines and regulatory requirements.

The ideal candidate has 3+ years in charge posting/claims and QA supervision, with CPT/ICD-10 knowledge and proficiency in Excel and PowerBI to monitor trends and

Qualifications

• 3+ years in charge posting and/or claims submission and reconciliation.
• QA-focused supervisory experience preferred.
• Strong CPT/ICD-10 knowledge and claims workflow experience.

Responsabilités

• Supervise day-to-day charge posting and claims readiness teams, including offshore resources.
• Review and audit claims submissions, edits, rejections, and charge entry for quality and timeliness.
• Perform routine QA audits with a 10–15% sample rate and log CPT/ICD-10 errors.
• Track, analyze and report error trends; provide monthly QA summaries to leadership.
• Use PowerBI and other tools to create dashboards with site-specific QA metrics.
• Maintain QA procedures and HIPAA/compliance standards.

Connaissances

CPT coding

ICD-10

Excel

QA auditing

PowerBI

QA oversight

Outils

NextGen

Waystar

EHR/PMS

Description du poste

EyeCare Partners is the nation’s leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit

Job Title: Quality Assurance Supervisor- Claims

MUST LIVE IN ONE OF OUR 18 States: Missouri, Florida, Kansas, Kentucky, Pennsylvania, Virginia, New Jersey, Texas, Minnesota, Michigan, Oklahoma, Alabama, North Carolina, Georgia, Illinois, Ohio, Indiana, Arizona

Job Summary

The Supervisor for RCM QA Charge Posting & Claims is responsible for overseeing quality assurance and performance across charge entry and claims management functions for multiple practices. This includes direct supervision of internal teams, oversight of co-sourced staff, ownership of QA auditing, workflow optimization, and process standardization. The Supervisor acts as a critical liaison between production teams and leadership, using data-driven insights to improve outcomes and ensure compliance with departmental standards, payer guidelines, and regulatory requirements.

Duties and 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, standard operating 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.

Experience Requirements

• Minimum Required: 3+ years of experience in charge posting and/or claims submission and reconciliation
• Preferred: 1-2 years in a supervisory and/or QA-focused role

Knowledge, Skills and Abilities Requirements

• Strong knowledge of CPT, ICD-10, and HCPCS coding and claims submission workflows
• Proficiency with billing platforms, clearinghouses, and EHR/PMS systems (e.g., NextGen, Waystar)
• Detail oriented, professional attitude, reliable
• Strong time management and organizational skills to support the leadership of this function
• Analytical and adaptable to evolving RCM structures and systems
• Skilled in error analysis, root cause investigation, and performance coaching
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to
• Avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and teammate support needs
• Able to communicate effectively in English, both verbally and in writing
• Ability to effectively engage and present to diverse audiences at all levels in the organization
• Capable of building strong cross-functional relationships and leading with influence
• Ability for basic to intermediate problem solving, including mathematics
• Intermediate to advanced computer operation
• Advanced skills with Microsoft Excel, Word, PowerPoint and Outlook
• Specialty knowledge of systems relating to job function
• HER/PMS Platforms (e.g. NextGen, Waystar)
• Other Quality Assurance Tools
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines
• Knowledge of payer guidelines, compliance requirements and HIPAA regulations

Supervisory Responsibilities

• Direct supervision of charge posting and claims production staff
• Oversight of QA auditing for on and offshore production teams
• Responsible for audit accuracy, performance coaching, escalation handling, and team development
• Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.
• Responsibilities include interviewing, hiring, and training employees, planning, assigning, and directing work; appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems

For remote team members

HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.