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This is a senior level role that will look at how the team currently sets up healthcare contracts in the system and makes sure there’s a clear, reliable way to check that the work is done correctly. This role will create step-by-step checks, guidelines, and training so mistakes are caught early, work is consistent, and fewer fixes are needed later. Additionally, they will look for parts of the checking process that can be automated to save time and help the team work faster and more accurately.
Job Responsibility:
Assess existing contract configuration and validation workflows
Develop a comprehensive QA process, including methodology, review steps, and quality checkpoints
Define criteria and test steps for validating reimbursement logic, contract rules, and payment outcomes
Recommend roles and responsibilities for analysts and QA reviewers, ensuring seamless handoffs
Create detailed process documentation, templates, and training materials
Identify and implement QA metrics and reporting needs to track improvements
Explore and recommend automation options for repetitive QA tasks to enhance efficiency
Collaborate with leadership and analysts to pilot and refine the QA process
Facilitate knowledge transfer to ensure the sustainability of the QA framework
Requirements:
5+ years' proven expertise in process design and QA framework development
Strong understanding of contract logic, payment rules, and configuration errors
Experience with managed care contracts and reimbursement methodologies
Ability to document processes clearly and translate complex requirements into actionable steps
Strong analytical and problem-solving skills
Experience in healthcare or revenue cycle environments is advantageous
Detail-oriented with excellent critical-thinking skills
Comfortable with ambiguity and capable of building structured processes
Independent worker with the ability to drive clarity in a dynamic environment
Strong communicator who can effectively collaborate across teams
Worked with software tools and salesforce from a QA perspective