Medical Billing Quality Assurance Specialist
4 days ago
This role plays a vital part in ensuring the accuracy, compliance, and efficiency of the revenue cycle process by reviewing claims, payments, denials, and related workflows.
Main Responsibilities:
- Conduct quality assurance audits to ensure adherence to established standards and client requirements.
- Review medical billing claims for accuracy in patient demographics, insurance details, CPT/ICD coding, modifiers, and charge entry.
- Maintain knowledge of HIPAA and U.S. healthcare compliance requirements.
- Analyze trends in errors and provide feedback to operations managers and team leads.
- Recommend corrective measures, retraining needs, or process improvements.
- Track performance metrics, including First Pass Resolution Rate (FPRR), Clean Claim Rate, Denial Rate, and AR Days.
- Collaborate with training teams to design refresher modules for billers and AR callers.
Required Skills and Qualifications:
- Bachelor's degree in healthcare, life sciences, or commerce.
- Minimum 3-5 years' experience in medical billing, coding, reporting, or AR calling; at least 1-2 years in quality audit.
- Strong knowledge of U.S. healthcare revenue cycle and relevant codes.
- Proficiency in MS Excel, quality tracking tools, and EMR/billing software.
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