Revenue Cycle Expert

5 days ago

Kolkata, West Bengal, India beBeeCompliance Full time ₹ 8,00,000 - ₹ 12,00,000
Job Description

A Medical Billing Quality Auditor ensures accuracy, compliance, and efficiency in the revenue cycle process by reviewing claims, payments, denials, and related workflows.

This critical role maintains high-quality standards for healthcare clients by monitoring billing, coding, accounts receivable calling, and credentialing activities, identifying errors, and recommending corrective actions.

Key Responsibilities:

  • Quality Assurance & Audit
  • Audit medical billing claims against company SOPs and client guidelines.
  • Review claims for accuracy in patient demographics, insurance details, CPT/ICD coding, and charge entry.
  • Monitor adherence to HIPAA and U.S. healthcare compliance requirements.
  • Conduct random audits on AR calling notes and eligibility checks.
  • Error Identification & Corrective Action
  • Identify trends in errors such as data entry mistakes and coding mismatches.
  • Provide feedback and detailed audit reports to operations managers and team leads.
  • Suggest corrective measures retraining needs or process improvements.
  • Performance Monitoring
  • Track team KPIs like First Pass Resolution Rate Clean Claim Rate Denial Rate and AR Days.
  • Evaluate compliance with SLAs turnaround times accuracy percentages.
  • Work with training teams to design refresher modules for billers and AR callers.
  • Documentation & Reporting
  • Maintain accurate audit logs scorecards and quality dashboards.
  • Present weekly/monthly audit summaries with trend analysis.

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