QA Analyst Medical Billing

Role & responsibilities

• Conduct regular quality audits of medical billing transactions, claims, and RCM processes.
• Review claims for accuracy, completeness, and adherence to client-specific guidelines.
• Identify errors related to patient demographics, insurance information, CPT, HCPCS, ICD-10 codes, modifiers, and billing requirements.
• Perform quality checks across claim submission, payment posting, denial management, AR follow-up, and other RCM functions.
• Ensure billing activities comply with US healthcare regulations, client requirements, and internal SOPs.
• Prepare and maintain daily, weekly, and monthly QA reports and audit reports.
• Monitor quality scores, error trends, recurring issues, and process deviations.
• Identify process gaps and recommend corrective and preventive actions (CAPA).
• Provide timely and constructive feedback to medical billers and process teams.
• Conduct root-cause analysis for recurring billing errors and quality issues.
• Coordinate with Team Leads, Managers, and Operations teams to resolve quality-related concerns.
• Conduct and participate in quality calibration sessions to ensure consistency in the audit process.
• Support process improvement initiatives to improve accuracy, productivity, efficiency, and claim quality.
• Maintain proper documentation of audit findings, errors, feedback, and corrective actions.
• Develop and update QA checklists, audit parameters, SOPs, and process guidelines.
• Identify and escalate critical errors, compliance issues, and recurring quality concerns to management.
• Conduct trend analysis and provide actionable insights to improve overall process quality.
• Maintain strict confidentiality of patient and client information in accordance with HIPAA and company policies.
• Ensure timely completion of assigned audits while meeting defined quality, productivity, and SLA requirements.

Preferred candidate profile

• Bachelor's degree in any discipline; Healthcare, Life Sciences, or RCM background preferred.
• 7+ years of relevant experience in medical billing, RCM, healthcare quality assurance, or a related function.
• Strong understanding of the US Healthcare Revenue Cycle Management (RCM).
• Strong knowledge of medical billing, claims processing, payment posting, denial management, and AR.
• Good understanding of CPT, HCPCS, ICD-10, modifiers, and claim forms.
• Experience in conducting quality audits and process evaluations.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and ability to identify process-level errors.
• Strong communication and interpersonal skills.
• Ability to provide effective feedback and collaborate with operations teams.
• Strong knowledge of MS Excel and QA reporting.
• Experience in root-cause analysis, process improvement, and quality monitoring.
• Ability to work independently and coordinate effectively with cross-functional teams.
• Willingness to work in Day Shift / US Business Hours.