Revenue Cycle Quality Assurance Analyst

Overview

The Revenue Cycle Quality Assurance (QA) Analyst is responsible for evaluating the accuracy, completeness, and compliance of daily account activity completed by Patient Access, Billing, Follow-Up, and Denial Management staff. This role ensures that all work meets established accuracy, compliance, and productivity/quality standards while supporting organizational performance goals. The QA Analyst will identify error trends, provide feedback to leadership, and recommend process improvements to enhance operational efficiency, reduce rework, and improve clean claim and resolution rates.

• Conduct daily and/or weekly audits of accounts worked by Patient Access Representatives, Billing Specialists, Follow-Up Representatives, and Denial Specialists.
• Validate accuracy of demographic, insurance, and authorization data entered during patient access processes.
• Review billing and claim submission activity for completeness, coding accuracy, and adherence to payer-specific rules.
• Assess follow-up actions for timeliness, accuracy, and effectiveness in resolving outstanding balances.
• Evaluate denial management work for correct root cause identification, appeal quality, and compliance with denial resolution workflows.
• Document audit findings and prepare detailed quality reports for leadership review.
• Identify recurring errors or gaps in processes and communicate actionable recommendations to department managers.
• Develop and deliver feedback to staff in collaboration with team leaders, supervisors, managers and directors to drive performance improvement.
• Partner with Revenue Cycle leadership to design corrective action plans based on QA results.
• Collaborate with training teams to address common errors through targeted education sessions.
• Assist in developing and refining quality monitoring tools, scorecards, and standard operating procedures.
• Ensure all account work complies with HIPAA, CMS guidelines, payer policies, and internal revenue cycle standards.
• Support the onboarding of new staff by participating in competency assessments and feedback sessions.
• Serve as a subject matter expert (SME) for quality review standards within the revenue cycle.
• Support readiness for external audits by maintaining accurate QA documentation.
• Monitor adherence to key organizational KPIs for quality and compliance.

• Associate's degree in healthcare administration, Business, or related field required; and/or
• Equivalent work experience may be considered in lieu of a degree.

• Minimum of 3 years of experience in hospital or physician revenue cycle operations, with exposure to Patient Access, Billing, Follow-Up, and Denial Management workflows.
• Prior auditing, quality assurance, or compliance experience strongly preferred.
• Experience with EHR and billing systems (Epic preferred).

• Strong knowledge of revenue cycle workflows, payer requirements, and regulatory guidelines.
• High attention to detail with the ability to identify trends and root causes of errors.
• Excellent organizational, analytical, and problem-solving skills.
• Proficient in Microsoft Office Suite, particularly Excel, for data analysis and reporting.
• Strong verbal and written communication skills with ability to convey findings clearly.

• Onsite position (based out of Greenville, NC)
• Monday - Friday day shift: 7:00 a.m.
  
  - 5:00 p.m.
• Great Benefits

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care,…