QA Specialist III - Client Success

Role and Responsibilities

• Apply advanced knowledge of payer requirements, client-specific guidelines, and quality assurance methodologies across a broad range of overpayment types and clients.           
• Perform quality assurance reviews of the highest complexity overpayments requiring advanced analysis, interpretation, and validation and update activities directly in client systems.
• Evaluate root cause determinations, calculations, and supporting documentation to ensure adherence to quality standards and client requirements.
• Serve as a subject matter resource for quality review scenarios and client-specific requirements.    
• Support onboarding and development of new team members through knowledge sharing and best-practice recommendations.    
• Identify quality trends, recurring errors, and operational risks, and recommend process improvements to enhance quality, efficiency, and consistency. 
• Participate in New Client Implementation and the Quality Assurance Review of new clients from project initiation by collaborating with operational leadership, implementation teams, Client Success, and other stakeholders to understand new client expectations, workflows, and quality requirements.  
• Analyze implementation discussions and client communications to inform quality review process; Incorporate evolving client requirements into quality assurance standards, review methodologies, and requirement documentation to support successful implementation and ongoing operations.              
• Identify and communicate gaps, ambiguities, or potential quality risks and seek clarification as needed to ensure accurate New Client Implementation quality assurance review processes.    
• Maintain advanced knowledge of payer guidelines, client requirements and methodologies through ongoing professional development and training.           

Qualifications

• Bachelor’s degree in business, healthcare, or a related field. Demonstrated experience in the healthcare field may be substituted for education requirement.
• Solid knowledge of overpayment recovery services.
• Strong analytical skills
• Strong communication and interpersonal skills, displaying the ability to connect and build relationships with payer clients, management, and peers.
• Team player with a strong desire to be an active long-term participant in the growth of the firm overall.
• Ability to learn quickly, make an immediate impact and provide value-added service.
• Attention to detail.
• Experience working under tight deadlines

Mental and Physical Demands

• This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and printers.
• The nature of the work is sedentary, and the employee will be sitting most of the time.
• Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
• Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.

Related Duties as Assigned

• This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.
• Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.