Quality Assurance Specialist

Description

Job Title: Quality Assurance Specialist

Job Summary: The Quality Assurance Specialist serves as the key point of contact between the program and billing departments, ensuring the accuracy, integrity, and efficiency of the billing process. This role is responsible for conducting quality assurance checks before billing submission, identifying and reporting denial and accounts receivable (AR) trends, and creating, maintaining, and documenting revenue cycle workflows within the program. The ideal candidate has strong analytical skills, a deep understanding of billing and reimbursement processes, and a proactive approach to process improvement

Key Responsibilities

• Pre-Billing Quality Assurance:
• Review client records, documentation, and service data to ensure all billing requirements are met prior to claim submission.
• Flag and resolve documentation or data discrepancies in collaboration with clinical and billing teams.
• Ensure billing is aligned with payer rules, internal policies, and regulatory standards.
• Revenue Cycle Monitoring and Reporting:
• Analyze and report on denial trends and AR issues, identifying root causes and recommending corrective actions.
• Monitor program-specific billing metrics and KPIs to ensure optimal revenue capture.
• Partner with the billing team to resolve claim denials, rejections, and payment delays.
• Process Development and Documentation:
• Develop and document standard operating procedures (SOPs) for billing-related activities at the program level.
• Act as the subject matter expert on program-specific billing requirements and workflows.
• Train program staff on billing cycle documentation standards and process updates.
• Liaison and Collaboration:
• Serve as the central liaison between program operations and the billing department to ensure seamless communication and issue resolution.
• Attend regular meetings with program and revenue cycle teams to review performance and address challenges.
• Communicate proactively with stakeholders to maintain transparency and alignment across departments.
• Compliance and Audit Support:
• Support internal and external audits by providing documentation and clarifying program-level billing procedures.
• Ensure ongoing compliance with payer guidelines, HIPAA regulations, and organizational policies.
  
  

Requirements

Qualifications:

Education: Associate or bachelor’s degree in health administration, Business, or related field preferred.

Experience

• 2+ years in medical billing, revenue cycle, or healthcare operations.
• Experience working in behavioral health, outpatient, or multi-payer settings is a plus.
• Bilingual English/Spanish preferred but not necessary
  
  

Skills And Competencies

• Strong attention to detail and accuracy.
• Knowledge of insurance billing guidelines and denial management.
• Proficiency in billing systems and electronic health records (EHR).
• Strong communication and organizational skills.
• Ability to analyze data and generate actionable insights.
• Proactive and solutions-oriented mindset.
  
  

We are proud to be an EEO employer M/F/D/V. We maintain a drug-free workplace. COMHAR, Inc. is a not-for-profit community based health and human service organization founded in 1975. We do not discriminate in services or employment on the basis of race, color, religion, ancestry, national origin, sex, sexual orientation, gender identity, age, disability, past or present receipt of disability-related services or supports, marital status, veteran status, or any other class of persons protected by federal, state or local law.