Medical Billing, Quality Assurance

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct thorough quality assessments of all Medicare/Medicaid claims following coding and prior to submission to ensure precision, compliance, and completeness.

• Review patient care reports (PCRs) to verify that documentation supports the billed service level and complies with payer guidelines and medical necessity criteria.

• Confirm the accuracy of coding selections, including service level classifications, mileage correctness, and necessary clinical indicators.

• Guarantee that documentation aligns with federal, state, and payer regulations, encompassing signature requirements, narratives, interventions, and supporting information.

• Ensure claim preparedness by confirming that all necessary documentation and attachments are included before claim release.

• Detect discrepancies or mistakes and take appropriate measures to rectify, escalate, or return claims to coders for further examination.

• Maintain a high-volume workflow while consistently achieving accuracy and productivity standards.

• Collaborate with Coding, Billing, QA leadership, and other internal teams to address inquiries or clarify documentation concerns.

• Promote continuous quality improvement by identifying trends, gaps, or potential training needs.

• Perform additional job responsibilities as assigned.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• A clinical or medical background is strongly preferred, including roles such as LPN, RN, EMT, Paramedic, LNA, Medical Aide, or equivalent experience.

• Strong comprehension of medical terminology, EMS clinical documentation, and healthcare billing standards.

• Capability to efficiently navigate and work across multiple computer programs simultaneously.

• Reliable home internet connection with speeds of 15 Mbps or higher is required.

• Successful completion of a basic computer skills assessment is mandatory prior to the interview; a typing test for speed and accuracy may also be requested.

• Exceptional attention to detail, accuracy, and skills in document review.

• Strong time-management abilities with the capability to meet stringent deadlines while maintaining high productivity levels.

• Ability to stay focused, organized, and productive in a remote, independent work setting.

• Strong written and verbal communication skills, with a professional demeanor and sound judgment.

• Reliable, punctual, and comfortable with asking questions or seeking clarification when necessary.

• Capability to remain calm and effective within a fast-paced, time-sensitive workload environment.

• Proficiency in independently managing all aspects of the job role, including meeting required goals and adhering to business practices in a remote environment.

🏝️ Benefits

• Competitive salary, aligned with experience.

• Comprehensive benefits package.

• 401(k) Plan.

• Equal Opportunity Employer.