Quality Assurance Specialist III
N/A, OFFSITE
Experience: 5
Education: GED, High School
Category: Healthcare
Contractor Work Model: Remote
Brand: System One
Compensation Range: 36.92 - 38.00 Per Hour
Job ID: 346491
Date Posted: 02/19/2026
Shortcut: http://jobs.systemone.com/o2e0V6
Medical Coding Quality Assurance Specialist
Location: Remote
Job Type: Contract to hire
Salary: $36.92/HR
Objective:
A major Blue Cross Blue Shield health plan is seeking an experienced Quality Assurance Specialist with strong medical coding audit expertise to perform prepayment reviews of medical records and claims. This role audits coding accuracy, evaluates provider billing behavior, ensures correct claim adjudication, and supports compliance across claims, enrollment, and service operations. You’ll work independently, manage high volume reviews, and serve as a subject matter expert (SME) in procedure and E/M coding.
Job Responsibilities:
- Conduct in-depth prepayment medical record audits for accuracy, compliance, and correct CPT/E&M coding.
- Review claims from high volume providers under special review (e.g., urgent care 10K+ claims).
- Validate benefit payment, contract interpretation, and system/process accuracy.
- Document audit findings in PowerApps, Excel, and quality monitoring tools.
- Provide coaching, feedback, and improvement recommendations to internal teams.
- Work across multiple applications: Conduit, Facets G6, SharePoint, PowerApps, Excel.
- Participate in departmental projects and process enhancements.
- High School Diploma or GED
- 5+ years Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience
- 2 years experience as Quality Assurance Specialist
- CPC, CPC-A, COC, or CPMA (coding certification required)
- 2+ years medical coding QA/audit experience
- Strong Evaluation & Management (E/M) and procedure (CPT) coding
- Medical record auditing experience (pre or post payment)
- Ability to work autonomously and multi-task across 4+ systems
- Excel proficiency (filters, sorting, exports, documentation)
- Clear, proactive communication
- Must be located in the following states: WV, DE, PA, NC, NJ, NY, FL, TX, MD, VA and DC
- Proficient in Microsoft Office programs
- ECA Certified Quality Assurance Manager preferred
System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
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Ref: #851-Rockville-S1
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