
Healthcare Revenue Cycle Specialist
3 days ago
Medical Billing Quality Auditor
This role involves ensuring accuracy, compliance, and efficiency in the revenue cycle process by reviewing claims, payments, denials, and related workflows.
- Key Responsibilities:
- Audit medical billing claims, payment posting, denials management, AR follow-ups, and credentialing tasks against company SOPs and client guidelines.
- Review claims for accuracy in patient demographics, insurance details, CPT/ICD coding, modifiers, and charge entry.
- Monitor adherence to HIPAA and U.S. healthcare compliance requirements.
- Conduct random and targeted audits on AR calling notes, eligibility checks, and credentialing packets.
- Provide feedback and detailed audit reports to operations managers and team leads.
- Suggest corrective measures, retraining needs, or process improvements.
Qualifications
- Bachelor's degree (preferably 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).
- Familiarity with CPT, ICD-10, HCPCS codes, and payer-specific guidelines.
- Proficiency in MS Excel, quality tracking tools, and EMR/billing software.
Performance Metrics
- Accuracy rate in audited claims (> 98%).
- Reduction in denials and rework through early detection.
- Timely submission of audit reports.
- Contribution to team performance improvement and SLA adherence.
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