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 

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