Quality Assurance Specialist I

Full-time, benefits-eligible position. 40 hours per week, fully remote. Monday–Friday, 8:00 AM–5:00 PM.

Responsibilities

• Conduct quality assurance reviews across departments and payers to ensure billing accuracy and adherence to processes.
• Analyze audit results to identify recurring issues, errors, and process gaps; recommend and support system or workflow improvements.
• Validate Epic edits, payer configurations, and workflow updates to ensure accuracy and consistency across departments.
• Maintain detailed records of audit outcomes and prepare actionable reports for leadership review and strategic planning.
• Partner with leadership to identify trends and reduce preventable errors through targeted education.
• Collaborate with training and leadership teams to support observation sessions and guide teammates requiring additional assistance, ensuring alignment with current SOPs and best practices.
• Support the implementation of new processes, workflows, and tools designed to improve billing efficiency and accuracy.
• Stay current on Advocate Health policies, Epic updates, and payer requirements to ensure continued compliance and operational readiness.
• Audit follow-up representatives’ accounts, review work queues, high-dollar accounts, and aged receivables.
• Support special projects assigned by leadership to strengthen operational integrity.
• Develop reports and spreadsheets to identify system and process deficiencies.
• Collaborate with cross-functional teams to address issues and ensure compliance with billing regulations, payer requirements, and applicable standards.

Requirements

• High school diploma or GED required.
• Minimum 3 years of experience in billing operations workflows with a focus on quality.

Skills

• Strong analytical and problem-solving skills, combining creativity and logical reasoning to troubleshoot issues and drive effective decision-making.
• Excellent written and verbal communication skills; able to present complex information clearly to various audiences.
• Thorough understanding of the healthcare revenue cycle—billing, denials, payer systems, and regulatory compliance—with a strong emphasis on quality assurance.
• Proficient in Microsoft Office Suite (Excel, Word, PowerPoint), and quick to learn new technologies and systems, with experience using healthcare information systems.
• Quick to learn new technologies and tools, with a proven ability to adapt to evolving systems and processes in support of quality monitoring and operational excellence.

Physical Requirements and Working Conditions

• Requires sitting for long periods of time.
• Requires bending and may need to lift up to 10 pounds occasionally.

Preferred Qualifications

• Associate or bachelor’s degree in healthcare administration, business, or related field.

Pay

$22.90 – $34.35 per hour.

Benefits

• Paid Time Off programs.
• Health and welfare benefits including medical, dental, vision, life, and short- and long-term disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.
• Premium pay such as shift, on-call, and more based on the teammate's job.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.).