Job 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