Analyst-Insurance Coverage Quality

Description

Job Summary

Job Summary
The Insurance Coverage Quality Analyst is responsible for ensuring accurate and timely insurance
coverage updates across patient accounts. This role focuses on improving coverage validation reducing
self-pay balances and minimizing billing errors through proactive account reviews customer service
engagement and workflow optimization.

Required Population Served

Job Responsibilities

Job Responsibilities
Add and correct insurance coverage on patient accounts.
Perform retro authorizations and rebill accounts as needed.
Validate coverage for discharged patients.
Conduct daily future and post-discharge self-pay scrubs (30 60 and 90-day).
Review eligibility denials for potential coverage by other payers and DSH eligibility.
Manage Out-of-Network (OON) work queues and ensure all commercial insurances are added for
OON accounts.
Monitor and resolve failed billing account work queue errors related to coverage effective dates
and validation checks.
Provide staff education on coverage processes and best practices.
Work closely with facility teams on First Source identified coverage and in-house insurance
changes.
Completes additional assignments as needed.

Specifications

Experience
Description Minimum Required Preferred/Desired

Minimum 2 years in insurance
verification billing or revenue
cycle operations. Familiarity with
Hospital and Physician Billing
workflows.

Education
Description Minimum Required Preferred/Desired
Associates or Bachelors degree
in Healthcare Administration
Business or related field
preferred.

Training
Description Minimum Required Preferred/Desired

Special Skills
Description Minimum Required Preferred/Desired
Strong attention to detail and
analytical skills. Excellent
communication and customer
service abilities. Proficiency in
healthcare billing systems and
work queue management.

Licensure
Description Minimum Required Preferred/Desired

Required Experience:

IC