The QA – Physician Billing is responsible for ensuring accuracy, compliance, and quality of AR processes related to physician billing. The role focuses on auditing AR work, identifying trends in denials and underpayments, ensuring adherence to payer guidelines, and driving process improvements to maximize reimbursements.
Perform quality audits on Physician Billing AR work including follow-ups, appeals, and payment postings
Review EOBs, ERAs, and payer correspondence for accuracy and compliance
Validate correct application of payer rules, contract terms, and coding guidelines
Identify root causes of denials, underpayments, and write-offs
Track and report QA scores, error trends, and performance metrics
Provide feedback, coaching, and corrective action plans to AR teams
Ensure compliance with HIPAA, payer policies, and internal SOPs
Support process improvement initiatives and best practices
Assist in training new AR staff on quality standards
Collaborate with Team Leads, Managers, and Coding teams to resolve issues
