Medical Billing Quality Lead

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services. Job Details: The Medical Billing Quality Lead is a key player in ensuring the integrity and efficiency of the revenue cycle. This role demands a sharp eye for detail, a proactive mindset, and a deep understanding of billing systems and claim workflows. You’ll be responsible for identifying and resolving claim rejections, auditing billing accuracy, and collaborating across teams to uphold compliance standards. With a focus on continuous improvement and data-driven insights, you’ll help streamline operations and elevate the quality of billing practices across multiple platforms including HCN, CPR+, and CareTend.

Responsibilities

Daily Tasks:

• Resubmit future claim rejections in Waystar based on current end dates of service
• Credit and rebill claims as needed
• Work rejections received in Waystar, as well as rejections received by Payer and Intermediary
• Send daily Unbilled Reports for HCN, CPR+, and CareTend to billing team
• Review claims queue across all platforms
• Collaborate with internal stakeholders to ensure timely claim submission
• Resolve unassigned claims in HCN
• Send Business Unit (BU) Team Name Matching Rejection Correction Email Requests

Weekly Tasks:

• Maintain and distribute Diagnosis Rejection Report to designated Intake team
• Compare QA Rejections Report against benchmark data
• Share team member error trends with leadership
• Track and communicate rejection trends
• Generate and send HCN Delivery Ticket/Doc Hold Reports to leadership/partners

Monthly Tasks:

• Prepare for JCAHO audits by proactively pulling clean claims/orders per partner
• Execute write-off and adjustment projects

End of Month (EOM) Tasks:

• Perform billing of lingering accounts during high-volume closing periods per partner
• Finalize corrections and adjustments for closing cycle
• Assist with claim corrections for items billed in incorrect accounting periods
• Complete rollbacks

As Needed (PRN) Tasks:

• Perform secondary claim billing
• Perform additional duties and responsibilities as assigned to support evolving business needs and organizational priorities.

Required Skillset:

• Minimum 2 years of experience in medical billing or revenue cycle operations
• Proficiency in HCN and CPR+ platforms; familiarity with CareTend is a plus
• Demonstrated ability to analyze claim rejections and identify trends
• Strong understanding of billing workflows, claim lifecycle, and payer requirements
• Excellent written and verbal communication skills, including email etiquette
• Proven attention to detail and ability to work independently
• Experience with quality auditing and rollback processes
• Comfortable collaborating across departments and with leadership

Qualifications

• Prior involvement in JCAHO audits or compliance-related projects
• Experience with Waystar claim management and secondary billing
• Familiarity with adjustment/write-off procedures and accounting period corrections
• Ability to lead or mentor peers in billing best practices
• Strong problem-solving mindset with a focus on continuous improvement

CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire. CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country. Apply tot his job Apply To this Job