Description:

Role Summary

The AR Quality Auditor is responsible for evaluating the quality and accuracy of Accounts Receivable (AR) processes, identifying gaps, and driving continuous improvement across denial management, follow-ups, and resolution workflows. The role ensures adherence to client guidelines, payer protocols, and internal quality standards.

Key Responsibilities

• Perform quality audits on AR workflows including:
  • Denial management
  • Insurance follow-ups
  • Appeals and documentation
  • Payment posting validation (as applicable)
• Review accounts worked by AR associates and ensure:
  • Correct action taken based on payer guidelines
  • Proper documentation and notes
  • Accurate claim status interpretation
• Identify error trends and root causes in:
  • Denial handling
  • Underpayment identification
  • Escalation gaps
  • Process deviations
• Maintain and publish:
  • QA scorecards
  • Audit reports
  • Weekly/monthly quality dashboards
• Collaborate with:
  • Operations teams for process improvement
  • Training teams for refresher sessions
  • Clients (if required) for quality alignment
• Ensure compliance with:
  • HIPAA guidelines
  • Client SOPs
  • Internal quality benchmarks
• Participate in calibration sessions to standardize audit decisions
• Recommend and drive corrective action plans (CAPA) for low performers

Eligibility Criteria

• Minimum 4+ years of experience in AR (Accounts Receivable) in US Healthcare RCM
• Mandatory minimum 1 year experience as a Quality Auditor (AR QA)
• Strong understanding of:
  • Denials (CO, PR, OA codes)
  • Appeals and reconsiderations
  • Payer-specific guidelines (Medicare, Medicaid, Commercials)
  • EOB/ERA analysis
• Hands-on experience in:
  • AR calling / account resolution
  • Working on different billing systems / EMRs

Skills Required

• Strong analytical and auditing skills
• Excellent knowledge of AR workflows and denial management
• Ability to identify patterns and recommend improvements
• Good communication skills (written & verbal)
• Proficiency in Excel (reporting, trackers, dashboards)
• High attention to detail and accuracy

Requirements:

Preferred Qualifications

• Experience in handling multiple specialties (ASC, Physician Billing, Anesthesia, etc.)
• Exposure to quality frameworks (Six Sigma / Lean – good to have)
• Experience in training or coaching teams

Success Metrics (What Good Looks Like)

• High audit accuracy and consistency
• Reduction in repeat errors
• Improvement in team quality scores
• Effective feedback adoption by operations
• Measurable contribution to process improvements