RCM/ OPH Quality Assurance Supervisor

EyeCare Partners is the nation’s leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit www.eyecare-partners.com .

Job Title: RCM Quality Assurance Supervisor - (Retina)

Must reside in the following states : AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, VA

Job Summary

The Retina Quality Clinical Liaison is responsible for overseeing quality assurance, clinical compliance, and operational alignment across retina services within affiliated practices. This role ensures high standards of care by developing and maintaining quality assurance programs, conducting audits of clinical documentation and coding, and identifying opportunities for improvement through data analysis and performance metrics. Serving as a key liaison between Retina Division leadership and multi-specialty practice teams, the position facilitates communication, supports implementation of clinical standards, and promotes consistency in workflows and policies. The role also monitors performance indicators, prepares regular reports for leadership, and drives continuous quality improvement initiatives.

Duties and Responsibilities

Quality Assurance Clinical Oversight

• Develop, implement, and maintain quality assurance programs specific to retina services across all affiliated practices.
• Conduct routine audits of documentation, injection coding, diagnostic imaging coding, and surgical coding.
• Identify trends, risks, and improvement opportunities using quality metrics and clinical data.

Retina Liaison

• Act as the primary point of coordination between the Retina Division leadership and multi-specialty practice teams.
• Translate retina clinical standards and operational expectations to practice-level leadership and staff.
• Facilitate communication regarding policy changes, new clinical initiatives, and quality improvement programs.

Performance Monitoring Reporting

• Track key retina performance indicators including:

Coding and billing accuracy related to retina services

• Track, analyze, and report trends in errors, edits, and rejections; provide monthly QA and performance summaries to retina leadership and executive management.
• Resolve complex or escalated claims and charge issues, ensuring accurate documentation and communication.
• Use PowerBI and other reporting tools to create dashboards with site-specific and functional QA metrics.
• Review and audit claims submissions, edits, clearinghouse rejections, and charge entry for quality, accuracy, and timely processing.

Training Education

• Develop educational materials and best-practice guidelines for retina workflows within multi-specialty environments.
• Conduct training for teams on billing protocols, charge entry standards, and regulatory updates.
• Participate in weekly syncs with management to align QA findings with training strategy and offshore coaching plans.
• Coordinate with managers to address systemic training issues, identify process gaps, and implement improvements.

Process Improvement

• Lead continuous quality improvement (CQI) initiatives within retina programs.
• Collaborate with operations, compliance, and IT teams to standardize processes across sites.
• Implement evidence-based best practices to enhance patient outcomes and operational efficiency.
• Encourage cross-functional communication and support the transition to a more standardized and functional model across RCM.
• Maintain and update QA procedures, standard operating procedures (SOPs), and documentation aligned with current billing guidelines.

General

• Ensure compliance with HIPAA and all federal/state billing regulations.
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.

Experience Requirements

• Minimum Required: 3+ years of experience in Retina Revenue Cycle Management
• Preferred: 1-2 years in a supervisory and/or QA-focused role

Knowledge, Skills and Abilities Requirements

• Strong knowledge of CPT, ICD-10, and HCPCS coding and claims submission workflows
• Proficiency with billing platforms, clearinghouses, and EHR/PMS systems (e.g., NextGen, Waystar)
• Detail oriented, professional attitude, reliable
• Strong time management and organizational skills to support the leadership of this function
• Analytical and adaptable to evolving RCM structures and systems
• Skilled in error analysis, root cause investigation, and performance coaching
• Ability to follow or provi…