Job Summary:

The Quality Analyst is responsible for ensuring accuracy, compliance, and efficiency across medical billing processes. This role involves conducting audits, analyzing claims and documentation, identifying improvement opportunities, and collaborating with the team to maintain high standards of billing performance. The ideal candidate maintains robust attention to detail, excellent communication skills, and the flexibility to adapt to evolving business needs.

Key Responsibilities:

Quality Audits & Compliance
Conduct quality audits on medical billing processes, claims, and documentation to ensure accuracy, compliance, and adherence to industry standards and regulatory requirements.
Review and analyze medical records, claims, pre-billing activities, coding, and billing data to identify errors, discrepancies, and areas for improvement.
Stay updated on changes in medical billing regulations, coding guidelines, and industry best practices to ensure ongoing compliance.

Process Improvement & RCA




Perform Root Cause Analysis for recurring issues and implement corrective and preventive actions.
Participate in meetings, discussions, and cross-functional initiatives to identify process improvement opportunities.
Assist in resolving complex billing issues, denials, and appeals.

Quality Control & Reporting
Develop and maintain quality control procedures, guidelines, and checklists for consistent and accurate billing practices.
Monitor and track key quality metrics and prepare reports for management, highlighting trends, concerns, and recommended corrective actions.
Maintain Turnaround Time standards while upholding accuracy and quality expectations.

Team Collaboration & Training
Collaborate with team members to provide feedback, training, and guidance related to accuracy, documentation quality, and regulatory compliance.
Offer support to team and leadership as needed and adapt to evolving business requirements.

Qualified Attributes
Dem

📌 Quality Analyst Karnataka (India)
🏢 Getixhealth
📍 India