QA Specialist - RCM Team

About Abby Care

Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving.

Over 50 million Americans are family caregivers for loved ones without pay, tools, or support. Our mission is clear and ambitious: to train and employ family caregivers so they can get paid for the care they already provide at home.

Abby Care is building a tech-powered, family-first care platform to efficiently deliver care, improve health outcomes, and provide the best-in-class experience nationwide.

We are rapidly expanding our mission and looking for passionate team members to join. Abby Care has partnered with leading insurance plans, healthcare providers, and community organizations. We’re supported by top, mission-driven VCs to empower families throughout the country.

The Role

The schedule for this role needs to align with US timezones, specifically, Eastern Time. Exact hours will be discussed during the interviews or offer call.

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

The Requirements:

• 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

• 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

Our Values

1. Families First
   Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, “Would we want this for our own families?”

2. Urgency with Precision
   Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand.

3. Relentlessly Resourceful
   As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity.

4. Purpose with Positivity
   We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve.

5. Driven to Redefine What’s Possible
   We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care. 

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.

We are an equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation.