RCM/ OPH Quality Assurance Supervisor

Eye Care Partners Career Opportunities; Kentucky; A distancia; USD 70.000 - 100.000; Jornada completa

Descripción de la vacante

EyeCare Partners is seeking a Quality Assurance Supervisor- Claims to lead QA across charge posting and claims submissions. The role oversees internal teams and offshore resources, audits claims for accuracy, and uses PowerBI to report QA metrics.

You will train staff on billing protocols and ensure compliance with HIPAA and regulatory guidelines. The position supports a remote work environment with responsibilities across multiple practices, focusing on process improvements and data-driven

Formación

• 3+ years in charge posting and/or claims submission and reconciliation.
• Supervisory and/or QA-focused experience preferred.
• Strong knowledge of CPT, ICD-10, HCPCS coding and claims submission workflows.

Responsabilidades

• Oversee day-to-day charge posting and claims readiness operations across internal and offshore resources.
• Review and audit claims submissions, edits, rejections, and charge entries for quality and timely processing.
• Track and report trends in errors, edits, and rejections to leadership.
• Create dashboards with site-specific QA metrics using PowerBI and other tools.
• Train teams on billing protocols and regulatory updates; ensure HIPAA compliance.
• Maintain and update QA procedures and SOPs aligned with billing guidelines.

Conocimientos

Analytical skills

Interpersonal skills

Communication in English

Leadership

Herramientas

PowerBI

EHR/PMS systems

Excel

Word

PowerPoint

Outlook

Billing platforms

Clearinghouses

Descripción del empleo

Job Title: Quality Assurance Supervisor- Claims

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. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum.

MUST LIVE IN ONE OF OUR 18 STATES: 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.

• 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.
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• 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
• Strong knowledge of CPT, ICD-10, and HCPCS coding and claims submission workflows
• Proficiency with billing platforms, clearinghouses, and EHR/PMS systems (e.g., 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
• Interpersonal skills to support customer service, functional, and teammate support needs
• Able to communicate effectively in English, both verbally and in writing
• Capable of building strong cross-functional relationships and leading with influence
• Intermediate to advanced computer operation
• Advanced skills with Microsoft Excel, Word, PowerPoint and Outlook
• HER/PMS Platforms (e.g. Other Quality Assurance Tools
• 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.

All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.