Qasim K

Quality Auditor

Clearpath Medical Billing • Freiberufler

Feb 2024 - Present • 2 yrs 3 mos

I am an experienced Medical Billing Quality Auditor specializing in US Healthcare Revenue Cycle Management (RCM) with hands-on expertise in claims auditing, denial management, coding compliance, and AR analysis. I ensure accuracy, compliance, and maximum reimbursement for healthcare providers, billing companies, and medical practices. I have extensive experience working with Medicare, Medicaid, and commercial insurance payers, reviewing billing workflows to identify revenue leakage, compliance issues, and operational inefficiencies. Key Responsibilities Perform comprehensive medical billing audits to ensure accuracy in CPT, ICD-10, and HCPCS coding. Review claims submissions, charge entries, and payment postings for compliance with payer guidelines. Conduct AR and denial management audits to identify root causes of claim denials. Monitor RCM workflows including eligibility verification, prior authorization, coding, billing, and collections. Perform vendor billing audits to ensure outsourced teams follow best practices and maintain billing accuracy. Review Medicare, Medicaid, and commercial payer claims for compliance and reimbursement optimization. Create audit reports, KPI dashboards, and performance improvement plans for billing teams. Identify revenue leakage, underpayments, and overpayments during billing audits. Key Achievements Successfully audited thousands of medical claims, improving billing accuracy and reducing denial rates. Identified critical billing errors and revenue leakage, helping providers recover lost revenue. Reduced claim denial rates through root cause analysis and corrective action plans. Improved first-pass claim acceptance rates by strengthening billing quality controls. Developed audit frameworks and reporting dashboards used for vendor performance monitoring.