Medical Billing Quality Assurance Auditor

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

📋 Description

• Conduct audits on the daily work completed by billing personnel, encompassing claim submissions, follow-up actions, and collection efforts.

• Assess account documentation, actions performed, and billing results within the billing system for precision, completeness, and regulatory compliance.

• Identify mistakes, inconsistencies, and trends impacting reimbursement, operational efficiency, or adherence to regulations.

• Present audit findings, constructive feedback, and recommendations to billing staff and management.

• Oversee and audit special projects and initiatives, including credit card chargebacks, priority payer follow-ups, and AB75.

• Work collaboratively with team leads, supervisors, and managers to enhance policies, procedures, and workflows.

• Assist in training staff on documentation standards, payer requirements, billing procedures, and industry best practices.

• Engage in quality assurance efforts and compile leadership reports on audit outcomes, performance trends, and opportunities for improvement.

• Stay updated on industry regulations, payer policies, and updates to billing software.

• Facilitate internal and external audit requests by gathering necessary documentation, conducting reviews, and addressing inquiries.

• Execute manual Cross Workflow tasks, including AR Support Requests and AR Follow-Up Requests.

• Address urgent Patient Services emails related to invoices concerning legal representation and time-sensitive matters.

• Carry out compliance audits as assigned or requested.

⛳️ Requirements

• Ability to thrive in a fast-paced environment while ensuring accuracy and concentration.

• Strong organizational capabilities to guarantee deadlines are met.

• In-depth knowledge of medical billing and accounts receivable processes, including the claim lifecycle, denials, and payer regulations.

• Proficient in utilizing billing software and electronic health record (EHR) systems.

• High level of attention to detail and accuracy in reviewing documentation and financial records.

• Analytical skills to identify patterns, discrepancies, and areas for enhancement.

• Understanding of and adherence to HIPAA and other governmental and healthcare industry regulations.

• Strong written and verbal communication abilities to provide constructive feedback and report findings.

• Capability to work independently, manage multiple tasks, and effectively prioritize responsibilities.

• Comprehensive knowledge of insurance guidelines, including Medicare, other government payers, private insurance, self-insurance, and managed-care plans.

• Familiarity with auditing methods and principles within a healthcare revenue cycle context.

• Proficient in MS Office applications, including Outlook, Word, and Excel.

• Outstanding verbal and written communication skills.

• Excellent attention to detail and effective time management skills.

• Exceptional customer service abilities.

• High School Diploma required.

• Minimum of 3-4 years of experience in revenue cycle management.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive team environment with a focus on collaboration.

• Flexible work arrangements available.