Billing QA Specialist

Western Missouri Medical Center•Warrensburg, MO

37d•Onsite

About The Position

The Billing QA Specialist is responsible for ensuring clean, accurate claims are released prior to submission to minimize denials and rework. This role serves as a quality checkpoint in the revenue cycle, working within Meditech work queues to resolve claim edits, validate coding and billing compliance, and support overall revenue integrity. The Billing QA Specialist plays a critical role in reducing denials, improving cash flow, and achieving a >90% clean claim rate.

Requirements

High school diploma or equivalent.
An Associate's degree in Business-related field is required.
Must possess a minimum of 3+ (three) years of healthcare billing, revenue cycle, or claims experience.
Certification required or obtained within one year of employment (one or more of the following): CPC (Certified Professional Coder), CPB (Certified Professional Biller), CRCR (Certified Revenue Cycle Representative).
Experience working in an HER system (MEDITECH preferred).
Experience working in a claim scrubber (SSI preferred).
Strong understanding of CPT, HCPCS, ICD-10 coding basics, Claim edit and payer rules, Insurance billing workflows.
Familiarity with denial management and A/R follow-up.
Strong attention to detail.
Analytical/problem-solving skills.
Ability to identify root causes of billing errors.
Effective communication across departments.
Ability to manage high work volumes in a deadline-driven environment.

Responsibilities

Work MEDITECH claim edit work queues.
Resolve hard and soft claim edits prior to billing.
Review and Correct: Missing/invalid modifiers, CPT/HCPC and ICD-10 inconsistencies, NCCI edits and bundling issues, Authorization requirements, payer-specific billing rules.
Ensure all required documentation and coding elements are present before claim release.
Perform detailed review of high-dollar and high-risk claims.
Validate: Accurate payer selection, Correct billing entity (facility & professional), Charge integrity and completeness.
Prevent claims from being submitted with known errors.
Analyze common claim edit failures and denial trends.
Partner with Patient Access (eligibility/auth issues), Coding (coding accuracy and documentation), Billing (workflow/process issues).
Provide feedback to reduce repeat errors.
Collaborate with Coders, Denial Specialists, A/R Team.
Escalate complex or recurring issues to leadership.
Participate in workflow improvement initiatives.
Meet daily productivity targets for claim review and resolution.
Maintain compliance with CMS guidelines, Payer billing requirements, Organizational policies.