Medical Billing - Quality Assurance - Digitech - Remote

Sarnova

8d•Remote

About The Position

The QA Specialist plays a critical role in ensuring the accuracy, compliance, and quality of all Medicare and Medicaid claims before submission. In this high‑volume, detail‑driven position, the QA Specialist reviews patient care reports (PCRs), validates service levels and documentation, and confirms that all regulatory and payer‑specific requirements are met. This role requires clinical insight, exceptional attention to detail, and a commitment to maintaining the highest standards of billing integrity.

Requirements

High School Diploma or equivalent
Strong understanding of medical terminology, EMS clinical documentation, and healthcare billing standards
Ability to navigate and work efficiently across multiple computer programs simultaneously
Must have reliable home internet with speeds of 15 Mbps or higher
Must successfully complete a basic computer skills assessment prior to interview; typing test for speed and accuracy may also be required
Excellent attention to detail, accuracy, and documentation review skills
Strong time‑management skills with the ability to meet tight deadlines and maintain high productivity
Ability to remain focused, organized, and productive in a remote, independent work environment
Strong communication skills, both written and verbal, with professionalism and excellent judgment.
Dependable, punctual, and comfortable asking questions or seeking clarification when needed
Ability to remain calm and effective in a fast-paced, time‑sensitive workload environment
Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment

Nice To Haves

Clinical or medical background strongly preferred: LPN, RN, EMT, Paramedic, LNA, Medical Aide, or equivalent experience

Responsibilities

Perform detailed quality reviews of all Medicare/Medicaid claims after coding and before submission to ensure accuracy, compliance, and completeness
Examine patient care reports (PCRs) to confirm documentation supports the billed level of service and adheres to payer rules and medical necessity standards
Validate coding selections, including level of service assignments, mileage accuracy, and required clinical indicators
Ensure documentation compliance with federal, state, and payer regulations, including signature requirements, narratives, interventions, and supporting details
Verify claim readiness by ensuring all required documentation and attachments are present prior to releasing the claim
Identify discrepancies or errors and take action to correct, escalate, or return claims to coders for further review
Maintain high‑volume throughput while consistently meeting accuracy and productivity expectations.
Collaborate with Coding, Billing, QA leadership, and other internal teams to resolve questions or clarify documentation issues
Support continuous quality improvement by identifying trends, gaps, or training opportunities.
Additional job duties as assigned