[Hiring] QA Specialist - Medical Billing @Abby Care

Role Description

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.

Key Responsibilities:

• Quality Assurance & Auditing
  • Review and audit home health documentation, including:
    • Face-to-Face Encounter documentation
    • Plan of Care (485)
    • Authorizations
    • EVV (Electronic Visit Verification)
  • Validate accuracy of diagnoses and clinical documentation
  • Ensure compliance with U.S. healthcare and billing standards
  • Perform peer QA reviews as part of internal quality checks
• RCM & Billing Support
  • Support claims review and follow-up processes
  • Identify documentation gaps that may impact billing or reimbursement
  • Collaborate with the billing team to ensure clean claim submission
• Cross-Functional Collaboration
  • Work closely with care operations and clinical teams (nurses, providers)
  • Communicate findings and discrepancies clearly
  • Provide actionable feedback to improve documentation quality
• Reporting & Process Improvement
  • Track QA metrics such as:
    • Daily documentation review volume
    • QA scores
    • Compliance accuracy (RRS and other internal metrics)
  • Identify trends, errors, and process gaps
  • Recommend improvements to enhance QA processes and reduce errors

Qualifications

• 2–3 years of QA or auditing experience in healthcare or RCM
• Strong experience in home health billing and documentation (highly preferred / near-mandatory)
• 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
• Exceptional attention to detail
• Strong analytical and investigative mindset
• Ability to provide clear, constructive feedback
• Strong communication skills (written and verbal)
• Ability to work across multiple systems/screens efficiently
• High level of accountability and objectivity

Requirements

• Nice-to-have:
  • Clinical background (e.g., nurse or allied health professional)
  • Experience auditing home health care documentation
  • Experience working with EMR/EHR systems
  • Exposure to claims follow-up and denial management

Benefits

• Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – global team members are eligible for an annual company performance bonus.
• Generous paid time off. We provide 15 days of paid time off that allow you to recharge, along with 10 paid company US holidays.
• Team bonding. We love bringing our teams together. As a full-time employee, you’ll get to connect, collaborate, and have fun through team activities and our annual company retreat.
• Set Up for Success. We provide a company-issued laptop to support you in your role.
• Growth Opportunities. Build your leadership skills while working with teams in various markets across the US.