Quality Analyst -US Healthcare

Job Title: Quality Analyst US healthcare

Job Location: Perungudi, Chennai

Job Type: Full-time

Reports To : Manager- RCM

Position Overview:

The Quality Analyst (QA) in Medical Billing is responsible for reviewing and ensuring the accuracy, completeness, and compliance of medical billing /calling processes. The QA will monitor billing data, identify discrepancies or errors, and work closely with the billing team and calling team to implement corrective actions and improvements. The ideal candidate will have a strong understanding of medical terminology, coding systems (CPT, ICD-10, HCPCS), insurance policies, and healthcare regulations and do reporting works for the billing and calling teams.

Key Responsibilities:

• Quality Auditing: Review medical claims and billing records to ensure accuracy and compliance with healthcare regulations, payer policies, and internal guidelines.
• Data Validation: Perform audits on claim submissions, ensuring proper coding, correct patient information, and that the claims are correctly processed.
• Documentation Review: Verify that medical records, patient details, and billing codes, calling notes are accurately entered into the system.
• Identify Errors & Discrepancies: Detect and resolve errors or inconsistencies in the billing/calling process. Notify the billing team/calling team about discrepancies or incomplete information.
• Provide Feedback & Coaching: Offer constructive feedback and guidance to billing staff based on audit findings. Provide training to ensure improved quality and compliance.
• Regulatory Compliance: Ensure all billing processes comply with federal and state regulations (HIPAA, CMS, etc.).
• Reporting: Prepare and generate reports on quality audits, error rates, and compliance issues. Should be well versed in preparing reports for management level meetings and reviews. Track trends and provide recommendations for process improvements.
• Email Drafting and Presentation : Should have excellent experience record and knowledge in Email drafting and presentation skills to present reports through emails or direct presentations.
• Continuous Improvement: Collaborate with the billing team and management to implement process improvements and optimize the billing cycle.
• Communication: Act as a liaison between billing departments, healthcare providers, and insurance companies to resolve issues and ensure accurate payment processing. Should posses excellent English written and oral communication skills
• Maintain Confidentiality: Adhere to strict confidentiality policies to protect patient and payer information.

Requirements:

• Education: Bachelor’s or Masters degree
• Experience: Minimum 2-3 years of experience in medical billing, AR calling and healthcare quality assurance.
• Knowledge:
• Strong understanding of medical billing codes (CPT, ICD-10, HCPCS) / AR calling scenarios and calling notes.
• Familiarity with insurance processes, payer rules, and regulations.
• Knowledge of HIPAA compliance and healthcare regulations.
• Skills:
• Detail-oriented with the ability to spot errors and discrepancies.
• Strong analytical and problem-solving skills.
• Excellent communication skills for interacting with cross-functional teams.
• Proficiency in MS Office and billing software
• General :
• Should be willing to join immediately for work from office mode
• Should have proper documents from previous concerns
• Shift Timing : 11 AM to 8.00 PM
• Monday to Friday and 1st and last Saturday of every month will be working.
• Willing to attend a Direct interview at Perungudi branch
• Pls email to ceciliea@scioms.com for more details or interview schedule