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About the Role

The Billing Quality Specialist conducts pre-billing quality reviews to ensure billing documentation is accurate, complete, timely, and compliant before submission. This role supports billing integrity by reviewing documentation, identifying issues, communicating findings, and ensuring corrective actions. It also aids in denial prevention by identifying trends and workflow gaps, and supports HCBS Life Plan compliance.

Responsibilities

Conduct pre-billing documentation reviews to confirm services are supported and ready for Finance review prior to claim submission.
Identify missing, incomplete, inconsistent, or non-compliant documentation and communicate findings to program leadership and applicable staff.
Track pre-billing issues and follow up to ensure concerns are resolved within required billing timelines.
Collaborate with Finance regarding documentation readiness, billing questions, and audit findings.
Support denial prevention by identifying documentation trends, recurring errors, workflow gaps, and compliance risks.
Perform quality and compliance sampling audits as assigned to assess documentation, billing readiness, and program compliance.
Prepare and distribute audit reports that summarize findings, trends, corrective action needs, and recommendations for improvement.
Track and trend audit data to identify risk areas, recurring documentation concerns, and staff training needs.
Review HCBS Life Plan documentation and related service planning processes to support OMIG compliance.
Monitor HCBS Life Plan processes, including plan timeliness, documentation completeness, staff follow-up, and communication with applicable program staff.
Support the development and monitoring of policies, procedures, work instructions, and quality tools related to billing readiness, documentation review, and HCBS Life Plan processes.
Maintain HIPAA compliance and stay current with applicable billing, documentation, OMIG, and program-specific regulatory requirements.
Make recommendations for staff training, workflow improvements, and corrective actions based on audit findings and trend analysis.
Perform other duties as assigned by the supervisor.

Requirements

Must be able to perform all functions with minimal supervision.
Strong knowledge of billing documentation standards, Medicaid-funded service requirements, OMIG compliance expectations, and HCBS Life Plan processes.
Ability to conduct accurate pre-billing reviews, identify documentation risks, track and trend findings, communicate corrective actions clearly, and collaborate effectively with Finance, Quality, Compliance, and program leadership while maintaining confidentiality and role clarity.
A combination of training and experience other than the specified, if judged to be adequate for the job, may be considered.

Skills

Analytical Skills
Accuracy
Customer Oriented
Detail Oriented
Developing Others
Diversity Oriented
Ethical
Interpersonal
Leadership
Training & Presentation Skills
Reliability
Communication, Oral
Communication, Written
Valid driver’s license
Ability to provide own transportation
Travel to various locations
Bilingual in English and Spanish preferred

About the Company

Ibero American Action League is committed to the policy of equal employment opportunity.

Equal Opportunity

This policy expressly prohibits discrimination on the basis of sex, race, color, religion, creed, national origin, age, marital status, sexual orientation, disability, gender identity or expression, genetic predisposition or carrier status, domestic violence victim status, veteran status or status as a member of any other protected group or activity