Medical Billing - Quality Assurance - Digitech - Remote

QA Specialist

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.

• 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.

Essential Duties And 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.

Skills/Experience Required

• Education: High School Diploma or equivalent.
• Clinical or medical background strongly preferred: LPN, RN, EMT, Paramedic, LNA, Medical Aide, or equivalent experience.
• Strong understanding of medical terminology, EMS clinical documentation, and healthcare billing standards.
• 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.

Sarnova is an Equal Opportunity Employer

We offer a competitive salary, commensurate with experience, along with a comprehensive benefits package, including 401(k) Plan. EO/M/F/Veterans/Disabled. Our mission is to be the best partner for those who save and improve patients' lives. Excellence in delivering upon our mission is dependent upon having a diverse team that is empowered to bring their full, authentic self to work each day. We strive to create a workplace that reflects the communities we serve, and we are passionate about creating an inclusive workplace that promotes and values diversity. #digitech