Quality Analyst - AR RCM

As a Medical Billing AR Quality Analyst, you will be reviewing and analyzing accounts receivable processes to ensure accuracy, compliance, and efficiency in medical billing and collections. You will be auditing outstanding accounts, monitor key performance indicators, and identify areas for improvement in the revenue cycle management. This role also involves coaching and providing feedback to AR staff, developing quality control procedures, and ensuring adherence to regulatory guidelines and client-specific requirements. 

Key Responsibilities:

Review and Audit:

Examine AR processes, including claim submissions, follow-ups, and payment posting, to identify errors and areas of non-compliance. 

Quality Control:

Conduct audits of medical records, claims, and other relevant documents to ensure accuracy, completeness, and adherence to regulations. 

Denial Management:

Analyze claim denials, identify root causes, and work with relevant teams to resolve issues and prevent future denials. 

Performance Monitoring:

Track and analyze key performance indicators (KPIs), such as Days Sales Outstanding (DSO), and identify trends and areas for improvement. 

Reporting:

Prepare and present regular reports on quality metrics, performance trends, and areas for improvement. 

Training and Coaching:

Provide feedback and coaching to AR staff to improve their performance and ensure consistent adherence to quality standards. 

Process Improvement:

Identify and implement process improvements to enhance the efficiency and effectiveness of the AR process. 

Compliance:

Ensure that all AR activities comply with relevant regulations, such as HIPAA and other payer-specific requirements. 

Collaboration:

Collaborate with other teams, such as coding, billing, and patient access, to resolve issues and improve overall revenue cycle performance. 

1. Minimum 4 Years of experience in RCM and AR.
2. QA on Papers will be an added advantage