Quality Analyst- B&C (Oct)

MedExpert Billing; Chennai District; On-site; INR 600,000 - 900,000; Full time

Job summary

MedExpert Billing is seeking an experienced QA professional with Revenue Cycle Management expertise to monitor and audit billing activities, identify gaps, and drive process improvements.

You will lead quality audits, perform RCA, coach teams, and generate KPI reports to management. Knowledge of HIPAA and US payer guidelines is a plus.

This role requires strong analytical and communication skills and the ability to work with clients and internal stakeholders in a fast-paced environment.

Qualifications

• 4+ years of experience in RCM Billing and Coding.
• Minimum 1–2 years of experience in QA/Senior QA role preferred.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving abilities.
• Experience in handling client escalations and stakeholder communication is an added advantage.

Responsibilities

• Quality Monitoring & Auditing: Conduct quality audits for Billing & Coding and documentation.
• RCA: Perform RCA for recurring errors, denials, and process deviations; identify gaps and CAPA.
• Coaching & Calibration: Conduct calibration sessions; support training initiatives and refresher sessions.
• Reporting & Analytics: Prepare daily, weekly, and monthly QA reports; track KPIs and share insights with management.

Skills

Quality Analysis

Root Cause Analysis

CAPA Management

Trend Analysis

Communication Skills

Tools

QA Audit Tools

RCM/Medical Billing Applications

Job description

We are looking for an experienced QA / Senior QA professional with expertise in Revenue Cycle Management (RCM) – Billing and coding Experince. The candidate will be responsible for monitoring and auditing billing activities, ensuring process compliance, identifying quality gaps, performing Root Cause Analysis (RCA), and driving continuous quality improvement initiatives.

The ideal candidate should possess strong knowledge of medical billing, denial management, insurance follow-up, and quality auditing processes along with excellent analytical and communication skills.

Key Responsibilities

Quality Monitoring & Auditing

• Conduct quality audits for Billing& Coding and documentation.
• Evaluate calls based on process adherence, accuracy, compliance, and communication skills.
• Ensure adherence to HIPAA regulations and client-specific guidelines.
• Monitor agent performance and identify improvement opportunities.

Root Cause Analysis (RCA)

• Perform RCA for recurring errors, denials, and process deviations.
• Analyze quality trends and identify process gaps.
• Recommend corrective and preventive actions (CAPA).
• Collaborate with operations teams to reduce repeat audit failures.

Coaching & Calibration

• Conduct calibration sessions with internal teams and clients.
• Support training initiatives and refresher sessions.
• Assist in improving overall team quality scores.

Reporting & Analytics

• Prepare daily, weekly, and monthly QA reports.
• Track and analyze KPIs such as:
• Quality Scores
• Error Rates
• Productivity Metrics
• Compliance Scores
• Share audit insights and improvement plans with management.

Required Skills

Domain Knowledge

• Strong understanding of Ambulance Coding
• Revenue Cycle Management (RCM)
• Billing and coding (Ambulance coding)
• Medical Billing
• Experienced in Medicare and Medicaid

QA & RCA Skills

• Quality Analysis
• Calibration Process
• Root Cause Analysis (RCA)
• CAPA Management
• Trend Analysis

Technical Skills

• QA Audit Tools
• RCM/Medical Billing Applications

Eligibility Criteria

• 4+ years of experience in RCM Billing and Coding
• Minimum 1–2 years of experience in QA/Senior QA role preferred.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving abilities.
• Experience in handling client escalations and stakeholder communication is an added advantage.

Preferred Qualifications

• Experience in US Healthcare / Medical Billing domain.
• Strong understanding of payer guidelines
• Ability to work in a fast-paced environment.
• Good team handling and mentoring skills.