Billing QA Specialist: Clean Claims & Denial Prevention

Western Missouri Medical Center; United States; On-site; USD 52,000 - 76,000; Full time

Job summary

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).

Qualifications

• 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.

Responsibilities

• 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.

Skills

Attention to detail

Analytical problem-solving

Root-cause analysis

Cross-department communication

Time/volume management

Education

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)

Tools

MEDITECH

SSI claim scrubber

Job description

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).