Company
Healthcare
RCMQualityAssuranceSpecialist
Neural analysis suggests this role is
optimal for Senior candidates.
“RCM Quality Assurance Specialist. Skills: Quality Assurance, Revenue Cycle Management, AI Output Validation, Data Analysis. Audit claim work for accuracy. Audit documentation for accuracy”
What You'll Achieve.
Ensure accuracy in actions; Ensure accuracy in documentation; Ensure adherence to QA standards; Reduce recurring errors; Improve revenue recovery efficiency
Industry & Context.
Analytical mindset; Root cause analysis
Work in US time zones
What They're Looking For.
Must Have
4+ years RCM experience, 4+ years AR follow-up experience, 4+ years denial management experience, High-accuracy work, Advanced Excel proficiency, Advanced Google Sheets proficiency, Analytical mindset, Documentation skills, Ability to work independently, Effective in US time zones, Communication skills, Structured, actionable feedback ability
Nice to Have
Experience reviewing AI outputs, Experience validating AI outputs, Exposure to BI tools, Familiarity with healthcare systems
What You'll Do.
Audit claim work for accuracy
Audit documentation for accuracy
Audit adherence to QA standards
Review AI-generated outputs
Review human-generated outputs
Evaluate denial workflows
Evaluate payer portals
Evaluate claims processing activities
Identify recurring error patterns
Identify inconsistencies
Compare outputs against source-of-truth data
Build performance dashboards
Develop rule-based quality checks
Develop automated quality checks
Detect recurring errors
Reduce recurring errors
Translate error trends into feedback
Translate error trends into coaching inputs
Calibrate evaluation standards
Ensure scoring consistency
Track key quality KPIs
Track appeal outcomes
Track accuracy metrics
Collaborate with product teams
Collaborate with engineering teams
Surface reproducible AI issues
Surface reproducible workflow issues
How You'll Work.
Team & Collaboration
Product teams; Engineering teams; Operations teams
Communication Scope
Structured feedback; Actionable feedback
Full Job Description
## Accountabilities Audit claim work to ensure accuracy in actions, documentation, and adherence to established QA standards. Review and evaluate AI and human-generated outputs across denial workflows, payer portals, and claims processing activities. Identify recurring error patterns, drift, and inconsistencies by comparing outputs against source-of-truth data. Build and maintain QA scorecards, trackers, and performance dashboards using Excel, Google Sheets, or BI tools. Develop rule-based or automated quality checks to proactively detect and reduce recurring errors. Translate error trends into structured feedback and coaching inputs for billing associates and team leads. Maintain QA rubrics, calibrate evaluation standards across reviewers, and ensure consistency in scoring. Track key quality KPIs, including appeal outcomes, overturn rates, and accuracy metrics. Collaborate with product and engineering teams by surfacing reproducible AI or workflow issues. Requirements: 4+ years of experience in Revenue Cycle Management (RCM), AR follow-up, or denial management. Strong track record of high-accuracy work in fast-paced healthcare billing or claims environments. Advanced proficiency in Excel or Google Sheets, including pivot tables, lookups, and conditional logic. Strong analytical mindset with the ability to identify root causes rather than surface-level issues. Experience reviewing or validating AI-generated outputs is highly desirable. Strong documentation skills with the ability to define clear QA standards and processes. Ability to work independently and effectively in US time zones (9am–6pm ET). Strong communication skills with the ability to provide structured, actionable feedback. Exposure to BI tools such as Looker, Tableau, or Metabase is a plus. Familiarity with healthcare systems such as ModMed, NextGen, or Athenahealth is an advantage. Benefits: Competitive compensation aligned with experience in healthcare RCM and QA roles. Fully remote work setup based i
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