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Quality Control Analyst

Applications Submitted for this Position


Most Common Years of Experience


Bachelor's is the most common degree type

Job Description

The Quality Control Analyst audits claims to identify examiner and system errors. 

Maintains a solid working knowledge of Health plan and provider contracts, division of responsibility (DOFR), and CPT/ICD9 coding.

Audits daily professional and facility claims for assigned groups.

Flags claims for examiner errors.

Applies McKesson Claim Check software daily report edits to flag claims for correction.  Runs claims manually through McKesson Claim Check as needed.

Reviews all daily supplemental audit reports and takes appropriate actions.

Job Requirements

Experience in professional and institutional healthcare claims examining and auditing.


Must be well versed in reading healthplan DOFRs and understand all types of fee schedules, including risk pools.

Excellent knowledge of CPT, RBRVS, DRG, HCPCS and ICD-9 coding and regulations.

Software: Microsoft Office, EZ-Cap, McKesson Claim Check, Redbook, DRG Pricing Software

About the Agency:

Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!

Job Snapshot

Employment Type Contractor
Job Type Health Care, Nurse, Insurance
Education Not Specified
Experience Not Specified
Manages Others No
Industry Managed Care, Healthcare - Health Services, Insurance
Required Travel None
Job ID 23A*
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Quality Control Analyst

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