Senior Medical Billing Quality Analyst

4 days ago

Lucknow, Uttar Pradesh, India beBeeRevenue Full time ₹ 10,00,000 - ₹ 15,00,000
Medical Billing Quality Auditor Role

This position is a critical component of our healthcare revenue cycle process, ensuring accuracy, compliance, and efficiency in claim review, payment, denial, and related workflows.

The ideal candidate will be responsible for monitoring billing, coding, AR calling, and credentialing activities, identifying errors, and recommending corrective actions to maintain high-quality standards for U.S. healthcare clients.

Key Responsibilities:
  • Quality Assurance & Audit: Review claims for accuracy in patient demographics, insurance details, CPT/ICD coding, modifiers, and charge entry.
  • Compliance Monitoring: Monitor adherence to HIPAA and U.S. healthcare compliance requirements.
  • Audit Execution: Conduct random and targeted audits on AR calling notes, eligibility checks, and credentialing packets.
  • Error Identification & Corrective Action: Identify trends in errors (e.g., data entry mistakes, coding mismatches, underpayments).
  • Feedback & Reporting: Provide feedback and detailed audit reports to operations managers and team leads.
  • Corrective Measures: Suggest corrective measures, retraining needs, or process improvements.
  • Performance Tracking: Track team KPIs like First Pass Resolution Rate (FPRR), Clean Claim Rate, Denial Rate, and AR Days.
  • SLA Evaluation: Evaluate compliance with SLAs (turnaround times, accuracy percentages).
  • Training Collaboration: Work with training teams to design refresher modules for billers and AR callers.
  • Documentation & Reporting: Maintain accurate audit logs, scorecards, and quality dashboards.
  • Weekly/Monthly Audits: Present weekly/monthly audit summaries with trend analysis.
Qualifications:
  • Education: Bachelor's degree in 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: Strong knowledge of U.S. healthcare revenue cycle (charge entry, payment posting, denials, AR follow-up, credentialing, reporting).
  • Coding Skills: Familiarity with CPT, ICD-10, HCPCS codes, and payer-specific guidelines.
  • Technical Skills: Proficiency in MS Excel, quality tracking tools, and EMR/billing software.

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