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