QA Specialist - RCM Team

About the Role: We are looking for a detail-oriented QA Specialist to support our Revenue Cycle Management (RCM) and Billing Team. This role is responsible for reviewing clinical and billing documentation to ensure accuracy, compliance, and adherence to home health regulations in the U.S. healthcare system. This is a highly cross-functional role that works closely with billing, care operations, and clinical teams to improve documentation quality, reduce compliance risks, and strengthen overall QA processes. Note: The schedule for this role needs to align with US Eastern Time.

What You'll Do

• Review and audit home health documentation, including Face-to-Face Encounter documentation, Plan of Care (485), Authorizations, and EVV.
• Validate accuracy of diagnoses and clinical documentation, ensuring compliance with U.S. healthcare and billing standards.
• Perform peer QA reviews as part of internal quality checks.
• Support claims review and follow-up processes, identifying documentation gaps that may impact billing or reimbursement.
• Collaborate with the billing team to ensure clean claim submission.
• Work closely with care operations and clinical teams to communicate findings and provide actionable feedback.
• Track QA metrics (daily volume, QA scores, compliance accuracy) and recommend improvements to enhance processes.

What You Bring

• 2–3 years of QA or auditing experience in healthcare or RCM.
• Strong experience in home health billing and documentation (highly preferred).
• Knowledge of Plan of Care (485), Face-to-Face requirements, Authorizations, and EVV workflows.
• Familiarity with U.S. healthcare roles (e.g., MD, Physician, Nurse Practitioner).
• Experience reviewing medical documentation for accuracy and compliance.
• Strong investigative and analytical skills with exceptional attention to detail.
• Ability to work across multiple systems/screens efficiently and provide clear, constructive feedback.
• Bonus: Clinical background (e.g., nurse or allied health professional), experience working with EMR/EHR systems, and exposure to claims follow-up and denial management.

Benefits

• Competitive compensation packages with eligibility for an annual company performance bonus.
• Generous paid time off: 15 days of PTO along with 10 paid company US holidays.
• Company-issued laptop to support you in your role.
• Team bonding activities and an annual company retreat.
• Growth opportunities to build your leadership skills while working with teams across the US.