
Medical Billing Quality Specialist
1 week ago
High-quality standards are crucial for healthcare clients to ensure accuracy, compliance, and efficiency in the revenue cycle process.
A Medical Billing Quality Auditor reviews claims, payments, denials, and related workflows to identify errors and recommend corrective actions.
- Quality Assurance & Audit
- Audit medical billing claims against company policies and client guidelines, ensuring adherence to HIPAA regulations and U.S. healthcare compliance requirements.
- Error Identification & Corrective Action
- Identify trends in errors and provide feedback on data entry mistakes, coding mismatches, and underpayments.
- Suggest measures or process improvements to operations managers and team leaders.
- Performance Monitoring
- Track team KPIs like First Pass Resolution Rate (FPRR), Clean Claim Rate, Denial Rate, and Average Days in Accounts Receivable (AR).
- Evaluate compliance with Service Level Agreements (SLAs) and work with training teams to design refresher modules for billers and AR callers.
Key skills include excellent attention to detail, strong written and verbal communication, analytical ability, and knowledge of HIPAA regulations and compliance requirements.
A bachelor's degree in healthcare, life sciences, or commerce is preferred, along with 3-5 years' experience in medical billing, coding, or quality audit.
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