Quality Auditor, AR

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