Quality Auditor, AR
Avontix · Hyderabad · onsite · Posted 40d ago
Undisclosed4–9 yrsfulltimeSourced from
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Job Type
Full-time
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
Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.
Sourced from naukri
Skills
AuditingAR QAPHYSICIANbilling systemsPrAnesthesiaauditsPayment PostingDenial ManagementDenial HandlinghipaaMedicaidmedicareCAPAHealthcareAccounts ReceivableAR CallingCommunication Skillsoperationscompliance
About Avontix
Avontix
Analytics & KPO
182
employees
2014
12 years old
Hyderabad/Secunderabad, Telangana
India
₹4.1L PA avg
Avg at Avontix
About
A leading provider of Revenue Cycle Services in the US healthcare sector, focusing on documentation, coding, billing, and technology solutions.
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