Medical Billing- QC & SME

Medical Billing - QC & SME

exp- 5+yrs

immediate joiners are preferred

location- coimbatore chinnavedampetti

We are seeking a highly skilled and experienced Quality Control & Subject Matter Expert in Medical Billing to join our team. The QC/SME will be responsible for providing expertise, guidance, and support in all aspects of medical billing processes, ensuring compliance with industry standards, and optimizing billing workflows. This role requires in-depth knowledge of medical billing, coding, and revenue cycle management, as well as strong analytical and communication skills.

Key Responsibilities

• Quality Control: Regularly audit billing activities to identify and correct inaccuracies, ensuring a high level of accuracy in billing documentation and claims.
• Training & Mentorship: Conduct training sessions for junior billing staff, sharing insights and updating the team on the latest industry practices and guidelines.
• Data Analysis: Analyze billing data to identify trends, report performance metrics, and recommend improvements in revenue cycle management.
• Provide Expertise: Serve as the go-to expert on medical billing processes, policies, and best practices. Offer insights and solutions for complex billing issues and disputes.
• Process Improvement: Evaluate and refine billing processes to enhance efficiency, accuracy, and compliance with regulations and payer requirements.
• Compliance Assurance: Ensure adherence to local and international billing regulations, coding standards (e.g., ICD-10, CPT), and HIPAA compliance.
• Documentation & MIS Reporting: Maintain thorough documentation of billing practices, policies, and procedures. Generate regular reports on billing performance and key metrics.

Qualifications

• Experience: Minimum of 5 years of experience in medical billing, with a deep understanding of coding, reimbursement, and revenue cycle management.
• Certifications: Certified Professional Biller (CPB) or Certified Professional Coder (CPC) is preferred.

Skills

• Technical Proficiency: Strong knowledge of medical billing software and systems, preferably with experience in billing platforms commonly used in the healthcare industry.
• Analytical Skills: Excellent ability to analyze billing data, identify patterns, and develop strategies for improvement.
• Communication: Strong written and verbal communication skills, with the ability to explain complex concepts to non-expert team members.
• Attention to Detail: High degree of accuracy in documentation, billing, and coding to minimize claim denials and optimize revenue collection.

Benefits

• Competitive salary based on experience and qualifications.
• Opportunity for professional development and growth within the company.
• Supportive work environment in a collaborative team.