PB-QA (5-Jan-26)

ECLAT Health Solutions; Hyderabad; On-site; INR 500,000 - 700,000; Full time

Job summary

Eclat-Health-Solutions-4 is seeking a QA – Physician Billing professional in Hyderabad, India. The role involves auditing AR processes related to physician billing, ensuring accuracy, compliance with payer guidelines, and driving process improvements. Key responsibilities include conducting quality audits, reviewing EOBs and ERAs for compliance, and identifying trends in denials or underpayments. Candidates should have experience in billing audits, knowledge of coding standards, and the ability to provide effective feedback and coaching to AR teams.

Qualifications

• Experience in auditing billing processes and ensuring compliance.
• Strong ability to identify trends in denials and underpayments.
• Knowledge of payer guidelines and coding standards.

Responsibilities

• Perform quality audits on Physician Billing AR work.
• Review EOBs, ERAs, and payer correspondence for accuracy.
• Validate application of payer rules and contract terms.
• Identify root causes of denials and underpayments.
• Track QA scores, error trends, and performance metrics.
• Provide feedback and coaching to AR teams.

Skills

Attention to detail

Analytical skills

Knowledge of HIPAA compliance

Job description

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.

Key Responsibilities

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