QA Insurance Specialist

Essential Job Functions
• Perform audits on sampled claims, accounts and transactions per set guidelines and criteria. Identify and
report errors.
• Participate in client calls and understand the quality requirements both from process perspective and for
targets.
• Identify a method to achieve the quality targets and implement the same in consultation with operations
manager/team manager.
• Collect data on individual transactions (chart, claim, EOBs, etc.) on the errors.
• Provide 1:1 feedback and also send emails with the type of errors, etc. on a daily basis.
• Coach employees to minimize errors and improve performance.
• Provide input to the training team on common mistakes made to enhance training curriculum.
• Test files/batches for new clients/processes to be processed as part of familiarization.
• Generation of QA reports on a daily basis.
• Attainment of Internal & External SLA as per process defined.
• Strict adherence to the company policies and procedures.
Key Success Indicators/Attributes
• Ability to prioritize and multi-task in a fast-paced, changing environment.
• Demonstrate ability to work in all work types and specialties.
• Demonstrate ability to self-motivate, set goals, and meet deadlines.
• Demonstrate leadership, mentoring, and interpersonal skills.
• Demonstrate excellent presentation, verbal and written communication skills.
• Ability to develop and maintain relationships with key business partners by building personal credibility
and trust.
• Maintain courteous and professional working relationships with employees at all levels of the organization.
• Work in accordance with corporate and organizational security policies and procedures, understand
personal role in safeguarding corporate and client assets, and take appropriate action to prevent and
report any compromises of security within scope of position.
• Demonstrate excellent analytical, critical thinking and problem-solving skills.
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• Skill in operating a personal computer and utilizing a variety of software applications is essential.
• Extensive experience with quality audits, coaching and training as per process defined. Prepare and
maintain quality status reports.
• Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the
impact on reimbursement and accreditation is an added advantage.

Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-
insurance, and full understanding of hospital/physician billing. Minimum 1-4 years’ experience in Medical
Billing/Coding and experience with standard office software products. High School diploma or equivalent.