Medical Billing Quality Assurance Specialist

1 week ago

Guntur, Andhra Pradesh, India beBeeHealthcare Full time ₹ 10,00,000 - ₹ 15,00,000

Medical Billing Quality Auditor

Job Overview

This role involves ensuring high-quality standards for healthcare clients by monitoring billing, coding, AR calling, and credentialing activities.

Key Responsibilities
  • Audit claims: Review claims, payments, denials, and related workflows to ensure accuracy, compliance, and efficiency in the revenue cycle process.
  • Medical billing review: Audit medical billing claims against company SOPs and client guidelines to ensure compliance and accuracy.
  • Coding and charge entry: Review claims for accuracy in patient demographics, insurance details, CPT/ICD coding, modifiers, and charge entry.
  • Compliance and regulations: Monitor adherence to HIPAA and U.S. healthcare compliance requirements.
  • Error identification: Identify trends in errors (e.g., data entry mistakes, coding mismatches, underpayments).
  • Reporting and feedback: Provide feedback and detailed audit reports to operations managers and team leads.
Requirements
  • Education: Bachelor's degree in a relevant field (healthcare, life sciences, or commerce).
  • Experience: 3–5 years' experience in medical billing, coding, running reports or AR calling; minimum of 1–2 years in quality audit.
  • Knowledge and skills: Strong knowledge of U.S. healthcare revenue cycle, CPT, ICD-10, HCPCS codes, and payer-specific guidelines.
  • Proficiency: Proficiency in MS Excel, quality tracking tools, and EMR/billing software (e.g., DrChronos, AdvancedMD, Simple Practice, Therapy Notes, Athena, Epic).
Performance Metrics
  • Accuracy rate: Accuracy rate in audited claims (> 98%).
  • Denial reduction: Reduction in denials and rework through early detection.
  • Report submission: Timely submission of audit reports.
  • Team contribution: Contribution to team performance improvement and SLA adherence.

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