RCM/ OPH Quality Assurance Supervisor

Eye Care Partners Career•Ballwin, MO

2d•Remote

About The Position

The Retina Quality & Clinical Liaison is responsible for overseeing quality assurance, clinical compliance, and operational alignment across retina services within affiliated practices. This role ensures high standards of care by developing and maintaining quality assurance programs, conducting audits of clinical documentation and coding, and identifying opportunities for improvement through data analysis and performance metrics. Serving as a key liaison between Retina Division leadership and multi-specialty practice teams, the position facilitates communication, supports implementation of clinical standards, and promotes consistency in workflows and policies. The role also monitors performance indicators, prepares regular reports for leadership, and drives continuous quality improvement initiatives.

Requirements

Minimum Required: 3+ years of experience in Retina Revenue Cycle Management
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

Develop, implement, and maintain quality assurance programs specific to retina services across all affiliated practices.
Conduct routine audits of documentation, injection coding, diagnostic imaging coding, and surgical coding.
Identify trends, risks, and improvement opportunities using quality metrics and clinical data.
Act as the primary point of coordination between the Retina Division leadership and multi-specialty practice teams.
Translate retina clinical standards and operational expectations to practice-level leadership and staff.
Facilitate communication regarding policy changes, new clinical initiatives, and quality improvement programs.
Track key retina performance indicators including: Coding and billing accuracy related to retina services.
Track, analyze, and report trends in errors, edits, and rejections; provide monthly QA and performance summaries to retina leadership and executive management.
Resolve complex or escalated claims and charge issues, ensuring accurate documentation and communication.
Use PowerBI and other reporting tools to create dashboards with site-specific and functional QA metrics.
Review and audit claims submissions, edits, clearinghouse rejections, and charge entry for quality, accuracy, and timely processing.
Develop educational materials and best-practice guidelines for retina workflows within multi-specialty environments.
Conduct training for teams on billing protocols, charge entry standards, and regulatory updates.
Participate in weekly syncs with management to align QA findings with training strategy and offshore coaching plans.
Coordinate with managers to address systemic training issues, identify process gaps, and implement improvements.
Lead continuous quality improvement (CQI) initiatives within retina programs.
Collaborate with operations, compliance, and IT teams to standardize processes across sites.
Implement evidence-based best practices to enhance patient outcomes and operational efficiency.
Encourage cross-functional communication and support the transition to a more standardized and functional model across RCM.
Maintain and update QA procedures, standard operating procedures (SOPs), and documentation aligned with current billing guidelines.
Ensure compliance with HIPAA and all federal/state billing regulations.
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.
Indirect 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.