Revenue Cycle Quality Assurance Specialist

Emergicon,-LLC-1; Terrell (TX); Hybrid; USD 65,000 - 92,000; Full time

Benefits offered by this job

Health insurance

Dental

Vision

401(k) retirement plan

Life insurance

Short-term disability

Critical illness coverage

Job summary

Emergicon LLC, based in Terrell, TX, seeks a Revenue Cycle Quality Assurance Specialist to audit billing, coding, AR, and payments for accuracy and compliance. You will help build audit tools, scorecards, and standards for Emergicon’s growing QA program.

The ideal candidate has 3+ years in healthcare revenue cycle, with experience across Medicare/Medicaid and commercial payer types, and familiarity with billing systems. This hybrid role requires adherence to HIPAA and strong analytical skills.

Qualifications

• Associate degree in healthcare administration or related field required, or equivalent practical revenue cycle experience
• Minimum of three years of healthcare revenue cycle, medical billing, coding, accounts receivable, denial management, auditing, quality assurance, or compliance experience required
• Experience with end-to-end healthcare revenue cycle operations required
• Experience in healthcare billing or revenue cycle systems required
• Direct experience in revenue cycle quality assurance or auditing preferred
• EMS billing experience preferred
• Experience across Medicare, Medicaid, commercial, managed care, and self-pay accounts preferred
• Certifications such as CPMA, CPC, CRCR, CHC, CAC or comparable healthcare auditing, coding, or compliance certifications preferred

Responsibilities

• Perform audits of revenue cycle activity to ensure accuracy, timeliness, and compliance
• Audit full claim lifecycle including demographics, insurance eligibility, charge entry, claims, coding, denials, and AR
• Identify billing errors, missed charges, duplicate billing, preventable denials, and revenue leakage
• Conduct root-cause analysis to determine sources of errors
• Quantify the financial impact of audit findings and track corrective actions
• Maintain supporting documentation and follow-up audits to ensure issues are resolved
• Escalate significant or recurring compliance concerns to the Director of Compliance
• Develop QA reporting covering audit results, error rates, trends, and corrective actions
• Collaborate to develop or improve SOPs; maintain confidentiality of PHI
• Align with Emergicon’s core values and work standards

Skills

Analytical skills

Excel proficiency

Audit/revenue cycle

Root cause analysis

Automation/AI tooling

HIPAA privacy

Communication

Independence

Education

Associate degree

Healthcare auditing cert

EMS billing experience

Tools

Billing platform

Payer systems

Billing software

Clearinghouse systems

Job description

Founded in 2006, Emergicon has grown into the largestemergency medical billing company in Texas, serving fire departments and EMSagencies ranging from small rural operations to major Texas cities.Emergicon and Emergifire operate from a “service-first” culture built on hardwork, accountability, and kindness.

We are looking for an experienced Revenue Cycle Quality Assurance Specialist to join our complianceteam. In this role, you’ll serve as Emergicon’s dedicated quality checkon the revenue cycle — auditing billing, coding, accounts receivable, andpayment activity for accuracy, completeness, and compliance, then tracking correctiveaction until problems stay fixed. This position also helps build the audittools, scorecards, and standards for Emergicon’s growing quality assuranceprogram.

This is a hybrid positionbased out of our Terrell, TX office, with remote work available in accordancewith company policy.

ESSENTIAL DUTIES ANDRESPONSIBILITIES

• Performroutine, random, targeted, and risk-based audits of revenue cycleactivity, reviewing accounts for accuracy, completeness, timeliness,documentation, and adherence to established requirements
• Auditacross the full claim lifecycle, including patient demographics, insuranceand eligibility, charge entry, claims, coding and documentation, denialsand appeals, accounts receivable follow-up, payment posting, adjustments,write-offs, credits, refunds, and account notes
• Identifybilling errors, missed charges, duplicate billing, preventable denials,incorrect adjustments, underpayments, revenue leakage, and other qualityconcerns — and the patterns and recurring issues behind them
• Conductroot-cause analysis to determine whether errors result from employeeperformance, training, processes, systems, payer requirements, orinadequate controls
• Quantifythe financial impact of audit findings where appropriate
• Maintainaccurate supporting documentation for audit findings, track correctiveactions, and conduct follow-up audits to confirm issues stay resolved
• Escalatesignificant, recurring, or potential compliance concerns to the Directorof Compliance promptly
• Developand maintain quality assurance reporting covering audit results, errorrates, recurring findings, trends, financial impact, and correctiveactions
• Communicatefindings clearly and objectively, distinguishing individual performanceissues from training gaps, process deficiencies, system issues, andcompliance concerns
• Helpbuild and standardize Emergicon’s revenue cycle quality assurance program,including audit tools, scorecards, sampling methods, and writtenprocedures
• Reviewcurrent workflows and collaborate with revenue cycle leadership andsubject-matter experts to develop or improve standard operating procedures(SOPs)
• Maintainconfidentiality and objectivity throughout the audit process, andsafeguard protected health information and company financial information
• Alignwith and adhere to Emergicon’s core values
• Performother job-related duties as assigned

EDUCATION ANDEXPERIENCE

• Associate’sdegree in healthcare administration, business, or a related fieldrequired, or equivalent practical revenue cycle experience
• Minimumof three (3) years of healthcare revenue cycle, medical billing, coding,accounts receivable, denial management, auditing, quality assurance, orcompliance experience required
• Demonstratedworking knowledge of end-to-end healthcare revenue cycle operationsrequired
• Experienceworking in healthcare billing or revenue cycle systems required
• Directexperience in revenue cycle quality assurance or auditing preferred
• EMS orambulance billing (or other emergency-services healthcare billing)experience preferred
• Experienceacross Medicare, Medicaid, commercial, managed care, and self-pay accountspreferred
• CPMA,CPC, CRCR, CHC, CAC, or comparable healthcare auditing, coding, orcompliance certification preferred

KNOWLEDGE,SKILLS, AND ABILITIES

• Stronganalytical and investigative skills, including sampling, trendidentification, root-cause analysis, and quantifying financial impact
• Proficiencyin Microsoft Excel, including large data sets, lookups, and pivot tables
• Abilityto learn and audit within Emergicon’s billing platform and related payerand clearinghouse systems
• Abilityto design practical audit tools, scorecards, and error classificationsthat employees and leadership can understand and use
• Comfortadopting automation and AI-assisted tools that streamline audit andreporting work
• Alertto billing, documentation, payer, and compliance risks, and quick torecognize emerging trends
• Curious— asks why errors happen and investigates root causes rather than stoppingat the error
• Responsive— acts promptly on significant findings and communicates clearly with theright stakeholders
• Objectiveand consistent, applying documented audit criteria while stayingindependent from the teams being audited
• Strongdiscretion with protected health information and confidential companyinformation

WORKINGCONDITIONS

This position involves extended periods of sitting orstanding at a desk while working on a computer. Work is hybrid, splitting timebetween Emergicon’s Terrell, TX office and a remote environment that supportsthe safe handling of confidential financial and protected health information.

BENEFITS:

Emergicon invests in its people with a full benefitspackage: health insurance, dental, vision, life insurance, 401(k) retirementplan, and short-term disability and critical illness coverage.

Offer of position is contingent on passing a pre-employmentbackground check and drug screening.

With a close-knit"One Team. One Sound." culture, Emergicon offers real room to growfor people who want to make an impact in the EMS industry.

Emergicon LLC is anEEO Employer - M/F/Disability/Protected Veteran Status