RCM QA Lead: Claims & Charge Posting

Eye Care Partners Career Opportunities; Georgia; On-site; USD 70,000 - 95,000; Full time

Job summary

EyeCare Partners is seeking a Quality Assurance Supervisor- Claims to oversee QA for charge posting and claims management across internal and offshore teams. You will supervise QA audits, track trends, and ensure adherence to payer guidelines and HIPAA regulations.

The role requires strong coding knowledge (CPT/ICD-10), Excel and Power BI skills, and experience with NextGen or Waystar. Remote work is not specified; preference for Georgia residents.

Qualifications

• 3+ years in charge posting and/or claims submission.
• 1–2 years in a supervisory/QA-focused role preferred.

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.

Skills

CPT/ICD-10 coding

Excel

Power BI

Billing platforms

Regulatory compliance

HIPAA knowledge

Tools

NextGen

Waystar

EHR/PMS systems

Job description

EyeCare Partners is seeking a Quality Assurance Supervisor- Claims to oversee QA for charge posting and claims management across internal and offshore teams. You will supervise QA audits, track trends, and ensure adherence to payer guidelines and HIPAA regulations.

The role requires strong coding knowledge (CPT/ICD-10), Excel and Power BI skills, and experience with NextGen or Waystar. Remote work is not specified; preference for Georgia residents.