RCM/ OPH Quality Assurance Supervisor

Eye Care Partners • Grand Rapids, MI

4d • Remote

About The Position

The Supervisor for RCM QA Charge Posting & Claims is responsible for overseeing quality assurance and performance across charge entry and claims management functions for multiple practices. This includes direct supervision of internal teams, oversight of co-sourced staff, ownership of QA auditing, workflow optimization, and process standardization. The Supervisor acts as a critical liaison between production teams and leadership, using data-driven insights to improve outcomes and ensure compliance with departmental standards, payer guidelines, and regulatory requirements.

Requirements

• Minimum Required: 3+ years of experience in charge posting and/or claims submission and reconciliation
• Strong knowledge of CPT, ICD-10, and HCPCS coding and claims submission workflows
• Proficiency with billing platforms, clearinghouses, and EHR/PMS systems (e.g., NextGen, Waystar)
• Detail oriented, professional attitude, reliable
• Strong time management and organizational skills to support the leadership of this function
• Analytical and adaptable to evolving RCM structures and systems
• Skilled in error analysis, root cause investigation, and performance coaching
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to Avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and teammate support needs
• Able to communicate effectively in English, both verbally and in writing
• Ability to effectively engage and present to diverse audiences at all levels in the organization
• Capable of building strong cross-functional relationships and leading with influence
• Ability for basic to intermediate problem solving, including mathematics
• Intermediate to advanced computer operation
• Advanced skills with Microsoft Excel, Word, PowerPoint and Outlook
• Specialty knowledge of systems relating to job function
• HER/PMS Platforms (e.g. NextGen, Waystar)
• Other Quality Assurance Tools
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines
• Knowledge of payer guidelines, compliance requirements and HIPAA regulations

Nice To Haves

• Preferred: 1-2 years in a supervisory and/or QA-focused role

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.
• Performs other duties that may be necessary or in the best interest of the organization.
• Direct supervision of charge posting and claims production staff
• Oversight of QA auditing for on and offshore production teams
• Responsible for audit accuracy, performance coaching, escalation handling, and team development
• Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.
• Responsibilities include interviewing, hiring, and training employees, planning, assigning, and directing work; appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems

Benefits

• HIPAA compliant home office environment for remote team members
• Ability to work in a remote environment while performing required duties and remaining patient focused
• Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed