Medical Billing Quality Assurance Specialist

5 days ago

Kanpur, Uttar Pradesh, India beBeeQuality Full time ₹ 12,00,000 - ₹ 15,00,000

Medical Billing Quality Assurance Specialist

As a Medical Billing Quality Assurance Specialist, you play a vital role in ensuring the accuracy and efficiency of medical billing processes. Your responsibilities include reviewing claims for adherence to company standards and client guidelines, monitoring compliance with HIPAA and U.S. healthcare regulations, and identifying trends in errors.

Key Responsibilities:

  • Audit medical billing claims against established protocols and client requirements.
  • Verify accuracy in patient demographics, insurance details, CPT/ICD coding, modifiers, and charge entry.
  • Monitor compliance with regulatory requirements and industry standards.

Identifying Errors and Corrective Actions:

  • Recognize and report errors related to data entry, coding mismatches, underpayments, or other discrepancies.
  • Provide detailed audit reports and recommendations for corrective measures to operations managers and team leads.
  • Collaborate with stakeholders to implement process improvements and retraining needs.

Performance Monitoring:

  • Track key performance indicators (KPIs) such as First Pass Resolution Rate, Clean Claim Rate, Denial Rate, and Accounts Receivable Days.
  • Evaluate compliance with Service Level Agreements (SLAs) regarding turnaround times and accuracy percentages.

Qualifications and Skills:

  • 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 assurance.
  • Strong knowledge of U.S. healthcare revenue cycle management, including charge entry, payment posting, denials, and AR follow-up.
  • Excellent analytical and problem-solving skills, with attention to detail and strong communication abilities.

Benefits:

This role offers opportunities for professional growth and development, as well as a competitive compensation package that reflects your expertise and contributions.

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