Medical Billing Quality Analyst

3 weeks ago

Muntinlupa, Philippines Gear Inc Full time

About the job Medical Billing Quality Analyst

Designation

Quality Analyst

Job Level

Intermediate

Department

Medical Billing/AR

Reporting to

Senior Operations Manager

PURPOSE OF THE POSITION

The Quality Analyst (QA) in the Healthcare Accounts Receivable (AR) and Medical Billing team plays a critical role in maintaining service excellence by ensuring compliance with billing standards, payer guidelines, and internal processes.

The QA monitors work quality, provides actionable feedback, and partners with operations and training teams to drive performance improvements and reduce error rates. This role serves as a key checkpoint in the quality lifecycle ensuring claims are handled accurately and efficiently, supporting timely revenue recovery for our clients.

RESPONSIBILITIES Quality Assurance & Performance Monitoring
  • Audit a daily sample of billers\' case transcripts.
  • Document audit results in a standardized tracker and ensure completeness and consistency of findings.
  • Identify patterns and recurring errors from audit results and escalate major discrepancies or compliance risks to Team Leads or Ops Managers.
  • Collaborate with TLs and Trainers to align on recurring issues and plan targeted coaching or refresher training sessions.
  • Support calibration sessions to maintain scoring alignment with client and operational leads.
  • Provide clear and structured feedback to specialists based on audit results.
  • Handle QA-related inquiries, audit appeals, validate audit logic, and update feedback if necessary.
Reporting & Insights
  • Generate and analyze daily, weekly, or ad hoc QA reports to provide insights on team quality trends and process bottlenecks.
  • Flag outliers, productivity-to-quality gaps, and compliance risks in collaboration with Operations and Training.
  • Prepare QA summaries for client-facing decks and internal reviews as needed.
Cross-Functional Collaboration
  • Partner with Trainers and Operations to conduct joint root cause analysis and process refinement.
  • Participate in internal syncs, updates, or policy briefings to stay aligned with client expectations.
  • Support internal and external calibration sessions and provide QA representation in client or compliance reviews.
Job Requirements
  • Fluent in English (C1 level or above), with strong communication and leadership skills.
  • Excellent verbal and written communication skills in English, with the ability to express ideas clearly and concisely.
  • Be detail-oriented with strong analytical skills; proficient with MS Office and Google Drive.
  • Minimum of 1 year experience in healthcare AR, revenue cycle, or medical billing, with at least 1 year in a leadership role (external candidate).
  • In-depth knowledge of billing practices, payer guidelines, denial management, and compliance standards (e.g., HIPAA).
  • Strong analytical, decision-making, and problem-solving skills.
  • Comfortable using billing systems, claim portals, and productivity monitoring tools.
  • Ability to thrive in a fast-paced, client-driven environment.
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