Medical Denial QA / QC

We are seeking a meticulous Medical Denial Quality Assurance (QA) / Quality Control (QC) specialist. The ideal candidate will possess strong expertise in denial management and medical billing processes, playing a critical role in reviewing and improving the accuracy of denial appeals and resolutions. This position is vital for optimizing revenue cycles and ensuring high-quality claim submissions.

Key Responsibilities

• Perform QA / QC reviews of denied medical claims to identify root causes and coding / billing errors.
• Analyze denial trends and patterns to provide actionable insights for process improvements.
• Verify the accuracy of information used in appealing denied claims, including coding, documentation, and payer-specific guidelines.
• Collaborate with AR (Accounts Receivable) teams and coders to implement corrective actions and prevent future denials.
• Develop and deliver training sessions to enhance team knowledge on denial prevention and effective appeal strategies.
• Maintain comprehensive records of audit findings, corrective actions, and their impact on denial rates.
• Ensure adherence to industry regulations and compliance standards related to medical billing and denials.

Qualifications

Skills

Skills Required

Quality Control, Audit, Denial Management, collaborative work , Medical Billing