Claims Quality Assurance Analyst

Job not on LinkedIn

🔥 3 minutes ago

🐊 Florida, North Carolina, +4 more states – Remote

🐊 Florida – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

💵 $42.9k - $55.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Vaya Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1972

🛡️ Insurance

💼 Consulting

📦 Logistics

Insurance • Consulting • Logistics

Vaya Health is a North Carolina-based organization that manages services for individuals with behavioral health issues, including mental health and substance use disorders, intellectual and developmental disabilities (I/DD), and traumatic brain injuries (TBI). The organization provides Medicaid services tailored for these populations, focusing on a person-centered approach that connects members to the necessary care and support for their unique health and wellness goals. Vaya Health emphasizes collaboration across various care areas to ensure comprehensive support for its members, fostering healthier communities across the region.

📋 Description

• Perform thorough weekly quality reviews of Claims and Reimbursement department work processes for accuracy and completeness • Audit random samples of claim and enrollment specialists’ work • Evaluate staff understanding of procedures for resolving customer requests • Evaluate use of standard operating procedures, workflows, and tools • Document quality reviews by work type and functional area • Conduct weekly onboarding audits for new employees and provide feedback and coaching support • Report audit findings to managers and department leaders • Recommend new or modified processes and procedures to address accuracy errors • Prepare audit reports for internal business partners • Serve as subject matter expert for quality audit questions • Track open audit items and advocate for timely resolution • Use audit findings and trends to provide training support • Collaborate with internal business partners to identify procedure gaps and system deficiencies • Monitor resolution of identified system deficiencies • Perform other duties as assigned

🎯 Requirements

• High School Diploma or GED with at least 5 years of combined experience in health care claim processing specifically Medicaid, Medicare and other 3rd party payment sources OR an Associate Degree in a related field (preferred) with a combination of 2 years of post-degree experience in health care claim processing specifically Medicaid, Medicare and other 3rd party payment sources • Must live in NC, SC, GA, TN, VA, MD, or FL • Knowledge of claims adjudication processes, provider contracting and credentialing, and member eligibility • Well-developed understanding of the health insurance industry • In-depth understanding of healthcare data analysis • Proficiency in Microsoft Word, Excel, Outlook, and SharePoint • Proficiency in or ability to quickly learn the organization’s claims adjudication system and NC Tracks or another multi-payer management information system for NC DHHS • Strong attention to detail and data accuracy • Strong computer skills and ability to learn additional databases and review multiple applications/screens simultaneously • Strong time management skills • Effective verbal, written, and listening skills • Ability to make independent decisions and solve challenges in a timely, professional manner • Ability to work independently and with a team to meet deadlines • Required training and compliance with HIPAA, 42 CFR Part 2, and applicable confidentiality laws • Must sign a confidentiality statement • Ability to perform sedentary work, sit for extended periods, and lift up to 10 pounds • Close visual acuity and repetitive hand, wrist, and finger motion required

🏖️ Benefits

• Exempt position • Not eligible for overtime compensation • Remote, home-based work arrangement • Monday–Friday schedule