Insurance Coverage Quality Analyst

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.

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.
• Complete additional assignments as needed.