Revenue Cycle Quality Assurance Specialist

Emergicon•Terrell, TX

8d•Hybrid

About The Position

Emergicon, the largest emergency medical billing company in Texas, is seeking an experienced Revenue Cycle Quality Assurance Specialist to join its compliance team. This role is crucial for auditing billing, coding, accounts receivable, and payment activity to ensure accuracy, completeness, and compliance. The specialist will also be responsible for tracking corrective actions and contributing to the development of audit tools, scorecards, and standards for the company's quality assurance program. This is a hybrid position based out of the Terrell, TX office, with remote work options available.

Requirements

Associate’s degree in healthcare administration, business, or a related field required, or equivalent practical revenue cycle experience.
Minimum of three (3) years of healthcare revenue cycle, medical billing, coding, accounts receivable, denial management, auditing, quality assurance, or compliance experience required.
Demonstrated working knowledge of end-to-end healthcare revenue cycle operations required.
Experience working in healthcare billing or revenue cycle systems required.
Strong analytical and investigative skills, including sampling, trend identification, root-cause analysis, and quantifying financial impact.
Proficiency in Microsoft Excel, including large data sets, lookups, and pivot tables.
Ability to learn and audit within Emergicon’s billing platform and related payer and clearinghouse systems.
Ability to design practical audit tools, scorecards, and error classifications that employees and leadership can understand and use.
Comfort adopting automation and AI-assisted tools that streamline audit and reporting work.
Alert to billing, documentation, payer, and compliance risks, and quick to recognize emerging trends.
Curious — asks why errors happen and investigates root causes rather than stopping at the error.
Responsive — acts promptly on significant findings and communicates clearly with the right stakeholders.
Objective and consistent, applying documented audit criteria while staying independent from the teams being audited.
Strong discretion with protected health information and confidential company information.

Nice To Haves

Direct experience in revenue cycle quality assurance or auditing preferred.
EMS or ambulance billing (or other emergency-services healthcare billing) experience preferred.
Experience across Medicare, Medicaid, commercial, managed care, and self-pay accounts preferred.
CPMA, CPC, CRCR, CHC, CAC, or comparable healthcare auditing, coding, or compliance certification preferred.

Responsibilities

Perform routine, random, targeted, and risk-based audits of revenue cycle activity, reviewing accounts for accuracy, completeness, timeliness, documentation, and adherence to established requirements.
Audit across the full claim lifecycle, including patient demographics, insurance and eligibility, charge entry, claims, coding and documentation, denials and appeals, accounts receivable follow-up, payment posting, adjustments, write-offs, credits, refunds, and account notes.
Identify billing errors, missed charges, duplicate billing, preventable denials, incorrect adjustments, underpayments, revenue leakage, and other quality concerns, as well as the patterns and recurring issues behind them.
Conduct root-cause analysis to determine whether errors result from employee performance, training, processes, systems, payer requirements, or inadequate controls.
Quantify the financial impact of audit findings where appropriate.
Maintain accurate supporting documentation for audit findings, track corrective actions, and conduct follow-up audits to confirm issues stay resolved.
Escalate significant, recurring, or potential compliance concerns to the Director of Compliance promptly.
Develop and maintain quality assurance reporting covering audit results, error rates, recurring findings, trends, financial impact, and corrective actions.
Communicate findings clearly and objectively, distinguishing individual performance issues from training gaps, process deficiencies, system issues, and compliance concerns.
Help build and standardize Emergicon’s revenue cycle quality assurance program, including audit tools, scorecards, sampling methods, and written procedures.
Review current workflows and collaborate with revenue cycle leadership and subject-matter experts to develop or improve standard operating procedures (SOPs).
Maintain confidentiality and objectivity throughout the audit process, and safeguard protected health information and company financial information.
Align with and adhere to Emergicon’s core values.
Perform other job-related duties as assigned.