A Physician Billing Quality Assurance (QA) Analyst ensures accuracy, compliance, and efficiency in the revenue cycle by auditing medical claims, payments, and denials. They identify trends in errors, verify adherence to coding (ICD-10/CPT) and payer regulations, and provide coaching to billing teams to maximize reimbursement and reduce denials.
Key Responsibilities
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Audit AR & Billing: Perform regular audits of AR follow-ups, claim submissions, and payment postings for accuracy.
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Denial Management Analysis: Identify root causes of denials, underpayments, and incorrect write-offs to develop corrective actions.
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Compliance Review: Ensure all billing processes adhere to HIPAA, CMS regulations, and payer-specific contracts.
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Performance Tracking: Maintain QA scores and report error trends to management.
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Training & Feedback: Provide feedback to AR staff to improve performance and quality.
Required Skills and Qualifications
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Experience: Proven experience in medical billing, revenue cycle management, or coding, often requiring 2+ years of experience.
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Coding Knowledge: Strong understanding of ICD-10, CPT, HCPCS, and modifiers.
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Software Skills: Proficiency with medical billing software (e.g., Epic, Athena) and MS Excel.
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Analytical Ability: Strong analytical skills to review complex documentation and identify patterns.
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Communication: Excellent verbal and written skills for providing coaching.
