The QA - Physician Billing is responsible for ensuring accuracy, compliance, and quality of AR processes related to physician billing. The role focuses on auditing AR work, identifying trends in denials and underpayments, ensuring adherence to payer guidelines, and driving process improvements to maximize reimbursements.
Key Responsibilities
Perform
quality audits
on Physician Billing AR work including follow-ups, appeals, and payment postings
Review
EOBs, ERAs, and payer correspondence
for accuracy and compliance
Validate correct application of
payer rules, contract terms, and coding guidelines
Identify
root causes
of denials, underpayments, and write-offs
Track and report
QA scores, error trends, and performance metrics
Provide
feedback, coaching, and corrective action plans
to AR teams
Ensure compliance with
HIPAA, payer policies, and internal SOPs
Support
process improvement initiatives
and best practices
Assist in training new AR staff on quality standards
Collaborate with Team Leads, Managers, and Coding teams to resolve issues
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