
Senior Medical Billing Auditor
1 week ago
This role is crucial to maintaining high-quality standards for healthcare clients. We are seeking a highly skilled Medical Billing Quality Auditor to monitor billing, coding, and credentialing activities.
- We audit medical billing claims against company SOPs and client guidelines, ensuring accuracy in patient demographics, insurance details, CPT/ICD coding, modifiers, and charge entry.
- We review claims for accuracy, identify trends in errors, and provide feedback to operations managers and team leads.
- We track key performance indicators (KPIs) like First Pass Resolution Rate (FPRR), Clean Claim Rate, Denial Rate, and AR Days, evaluating compliance with Service Level Agreements (SLAs).
Key Responsibilities:
- Audit medical billing claims, payment posting, denials management, AR follow-ups, and credentialing tasks.
- Monitor adherence to HIPAA and U.S. healthcare compliance requirements.
- Conduct random and targeted audits on AR calling notes, eligibility checks, and credentialing packets.
Qualifications:
- Bachelor's degree in a relevant field, preferably in healthcare, life sciences, or commerce.
- 3-5 years of experience in medical billing, coding, reporting, or AR calling; minimum of 1-2 years in quality audit.
- Strong knowledge of U.S. healthcare revenue cycle processes.
- Familiarity with CPT, ICD-10, HCPCS codes, and payer-specific guidelines.
- Proficiency in MS Excel, quality tracking tools, and EMR/billing software.
Benefits:
- This position offers the opportunity to work with a variety of healthcare clients, gaining valuable experience in medical billing and quality audit.
- We prioritize ongoing training and professional development to ensure our team members stay up-to-date with industry best practices.
Others:
- We strive to maintain a positive work environment that fosters collaboration, innovation, and growth.
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