QA Analyst

Summary:

This position will transition to a hybrid role once the employee is fully trained and receives management approval.  Training will be completed on-site at our corporate office in Warwick, RI.

Under the general supervision of the Manager of Financial Systems and Analytics, the Quality Assurance Analyst is responsible for ensuring the accuracy, consistency, and usability of operational and financial reports used across the revenue cycle. This role plays a critical part in validating and auditing reports that track claim payments, reimbursements, denials, and other financial outcomes to ensure claims are processed and paid accurately according to payer contracts and policies. In addition, this role involves auditing data outputs, validating report logic, identifying discrepancies or anomalies, and working collaboratively with data/report developers, analysts, and operational teams to ensure data-driven decisions are based on reliable reporting.

Schedule:

• Monday-Friday 8:30 AM-5:00 PM

Principal Duties And Responsibilities:

• Perform quality assurance reviews of reports related to billing, payments, collections, and denial trends to ensure data accuracy and integrity.
• Identify errors, inconsistencies, or process inefficiencies through audits and data analysis.
• Manage and identify issues with monthly reconciliation for hospital and site data.
• Validate report logic, filters, and formulas against business requirements and source system data.
• Track and report error rates, trends, and compliance issues to leadership.
• Identify underpayments, overpayments, or other anomalies in claim-level financial data and escalate issues for further review or correction.
• Work cross-functionally with other departments to resolve complex issues.
• Maintain documentation of QA findings, resolution steps, and ongoing data quality checks.
• Work closely with coding vendors and ensure that missing data gets entered into the system.
• Participate in testing and validation efforts related to system upgrades, payer changes, or workflow adjustments that impact claim or payment data.
• Ensure compliance with HIPAA, CMS, quality programs, and organizational standards in all reporting activities.
• Create ACR reports based on IT generated files. Work with vendors to ensure accuracy and completeness.
• Maintain confidentiality and safeguard patient and financial data.
• All other duties as assigned.

Basic Knowledge/Skills:

• Strong understanding of hospital and/or physician billing processes
• Knowledge of insurance guidelines, claims processing, and denial management
• Familiarity with CMS regulations, HIPAA, and healthcare compliance standards
• Proficient in Microsoft Office (Excel, Word); experience with revenue cycle systems is a plus
• Excellent analytical, organizational, and problem-solving skills
• Strong written and verbal communication skills
• Ability to work independently and as part of a team in a fast-paced environment

Education:

• Associate degree or relevant coursework in billing, data analytics, or healthcare systems

Experience:

• 3+ years of experience in patient financial services, revenue cycle, medical billing, or related field
• Experience in quality assurance or auditing preferred

Join an award-winning organization! With numerous private, state-of-the-art medical diagnostic imaging facilities, join the team that has been providing Rhode Island with imaging excellence for over 80 years! The American College of Radiology has named RIMI one of the first outpatient diagnostic imaging Centers of Excellence in the country and the first in Rhode Island.  RIMI also has the honor of being named an eight-time winner of Providence Business News' Healthiest Employers of Rhode Island Award, most recently in 2025!

RIMI offers best-in-class benefits to eligible employees including multi-tiered health plans, flexible spending accounts, generous paid time off, 401(k) plan with profit sharing component, uniform reimbursement, company "swag," yearly reimbursement for continuing medical education, educational assistance (reimbursement) program, student loan repayment program, and career development opportunities. Enjoy competitive pay and all in our innovative culture that consistently provides the highest levels of quality, safety, technology, and patient care.