Healthcare Revenue Cycle Specialist

6 days ago

Gandhinagar, Gujarat, India beBeeMedicalBilling Full time ₹ 50,00,000 - ₹ 70,00,000

Job Summary:

We are seeking a Medical Billing Quality Assurance Specialist to join our team. The successful candidate will play a critical role in ensuring accuracy, compliance, and efficiency in the revenue cycle process.

This position is responsible for monitoring billing, coding, AR calling, and credentialing activities, identifying errors, and recommending corrective actions.

Key Responsibilities:

  • Quality Audit
  • Audit medical billing claims, payment posting, denials management, AR follow-ups, and credentialing tasks against company standards and client guidelines.
  • Error Identification & Corrective Action
  • Identify trends in errors (e.g., data entry mistakes, coding mismatches, underpayments).
  • Suggest corrective measures, retraining needs, or process improvements.
  • Performance Monitoring
  • Track team KPIs like First Pass Resolution Rate (FPRR), 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.

Requirements:

  • Bachelor's degree in healthcare, life sciences, or commerce.
  • 3–5 years' experience in medical billing, coding, running reports or AR calling; minimum of 1–2 years in quality audit.
  • Strong knowledge of U.S. healthcare revenue cycle (charge entry, payment posting, denials, AR follow-up, credentialing, reporting).

Preferred Skills:

  • Excellent attention to detail and analytical ability.
  • Strong written and verbal communication skills.
  • Ability to identify patterns/trends and provide actionable insights.

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