Role & responsibilities

- Conduct regular quality audits of medical billing transactions, claims, and RCM processes.

- Review claims for accuracy, completeness, and adherence to client-specific guidelines.

- Identify errors related to patient demographics, insurance information, CPT, HCPCS, ICD-10 codes, modifiers, and billing requirements.

- Perform quality checks across claim submission, payment posting, denial management, AR follow-up, and other RCM functions.

- Ensure billing activities comply with US healthcare regulations, client requirements, and internal SOPs.

- Prepare and maintain daily, weekly, and monthly QA reports and audit reports.

- Monitor quality scores, error trends, recurring issues, and process deviations.

- Identify process gaps and recommend corrective and preventive actions (CAPA).

- Provide timely and constructive feedback to medical billers and process teams.

- Conduct root-cause analysis for recurring billing errors and quality issues.

- Coordinate with Team Leads, Managers, and Operations teams to resolve quality-related concerns.

- Conduct and participate in quality calibration sessions to ensure consistency in the audit process.

- Support process improvement initiatives to improve accuracy, productivity, efficiency, and claim quality.

- Maintain proper documentation of audit findings, errors, feedback, and corrective actions.

- Develop and update QA checklists, audit parameters, SOPs, and process guidelines.

- Identify and escalate critical errors, compliance issues,



and recurring quality concerns to management.

- Conduct trend analysis and provide actionable insights to improve overall process quality.

- Maintain strict confidentiality of patient and client information in accordance with HIPAA and company policies.

- Ensure timely completion of assigned audits while meeting defined quality, productivity, and SLA requirements.

Preferred candidate profile

- Bachelor's degree in any discipline; Healthcare, Life Sciences, or RCM background preferred.

- 7+ years of relevant experience in medical billing, RCM, healthcare quality assurance, or a related function.

- Strong understanding of the US Healthcare Revenue Cycle Management (RCM).

- Strong knowledge of medical billing, claims processing, payment posting, denial management, and AR.

- Good understanding of CPT, HCPCS, ICD-10, modifiers, and claim forms.

- Experience in conducting quality audits and process evaluations.

- Strong analytical and problem-solving skills.

- Excellent attention to detail and ability to identify process-level errors.

- Strong communication and interpersonal skills.

- Ability to provide effective feedback and collaborate with operations teams.

- Solid knowledge of MS Excel and QA reporting.

- Experience in root-cause analysis, process improvement, and quality monitoring.

- Ability to work independently and coordinate effectively with cross-functional teams.

- Willingness to work in Day Shift / US Business Hours.

📌 QA Analyst Medical Billing (Hyderabad)
🏢 Zebl India
📍 Hyderabad