Billing QA Specialist: Clean Claims & Denial Prevention

Western Missouri Medical Center; United States; Presencial; USD 52 000 - 76 000; Tempo integral

Resumo da oferta

Western Missouri Medical Center is seeking a Billing QA Specialist to ensure clean, accurate claims are released prior to submission. This on-site role will focus on reviewing MEDITECH work queues, resolving claim edits, and validating coding and billing compliance to improve cash flow and maintain a >90% clean claim rate.

The ideal candidate has a minimum of 3 years in healthcare billing, an associate degree in a business-related field, and relevant certifications (CPC/CPB/CRCR).

Qualificações

• High school diploma or equivalent.
• Associate's degree in Business-related field is required.
• Minimum 3+ years of healthcare billing, revenue cycle, or claims experience.
• Certification required or obtained within one year: CPC, CPB, or CRCR.
• Experience working in a MEDITECH EHR system preferred.
• Experience working in a claim scrubber (SSI) preferred.
• Strong understanding of CPT, HCPCS, ICD-10 coding basics, claim edits and payer rules.
• Knowledge of insurance billing workflows and denial management.

Responsabilidades

• Claim Edit Resolution: review and resolve edits in MEDITECH queues before billing.
• Pre-Bill Quality Assurance: validate payer selection, billing entity, and charge completeness.
• Denial Prevention and Trend Identification: analyze denial patterns and communicate trends.
• Collaboration and Escalation: work with Coders, Denial Specialists, and A/R Team; escalate issues.
• Productivity and Compliance: meet daily targets and ensure CMS and payer compliance.

Conhecimentos

Attention to detail

Analytical problem-solving

Root-cause analysis

Cross-department communication

Time/volume management

Formação académica

High school diploma or equivalent

Associate's degree in Business-related field

CPC (Certified Professional Coder)

CPB (Certified Professional Biller)

CRCR (Certified Revenue Cycle Representative)

Ferramentas

MEDITECH

SSI claim scrubber

Descrição da oferta de emprego

Western Missouri Medical Center is seeking a Billing QA Specialist to ensure clean, accurate claims are released prior to submission. This on-site role will focus on reviewing MEDITECH work queues, resolving claim edits, and validating coding and billing compliance to improve cash flow and maintain a >90% clean claim rate.

The ideal candidate has a minimum of 3 years in healthcare billing, an associate degree in a business-related field, and relevant certifications (CPC/CPB/CRCR).