Revenue Cycle Auditor

Role & responsibilities

• Conduct quality audits for AR activities including:
• Insurance follow-ups
• Denial management and appeals
• Underpayment analysis
• Payment posting and adjustments
• Patient and insurance balance resolution
• Ensure adherence to client SOPs, payer rules, and HIPAA compliance.

• Identify error trends, root causes, and process gaps.
• Share structured audit feedback with AR associates, Team Leads, and Managers.
• Prepare and circulate daily, weekly, and monthly quality reports and scorecards.
• Participate in internal and client calibration calls.
• Support training and refresher sessions based on quality findings.
• Work closely with operations to improve First Pass Resolution (FPR) and reduce rework.
• Drive continuous process improvement initiatives.

Preferred candidate profile

• Minimum 4+ years of experience in US Healthcare Accounts Receivable (AR).
• Prior experience as a Quality Analyst or AR SME is mandatory.
• Strong hands-on knowledge of US Healthcare AR processes.
• Expertise in denial management, appeals, and EOB interpretation.
• Good analytical and root-cause analysis skills.
• High attention to detail and documentation accuracy.
• Strong verbal and written communication skills.
• Proficiency in MS Excel (Pivot Tables, VLOOKUP/XLOOKUP preferred).
• Experience with AR systems such as Athena, ECW, CGM, NextGen, Tebra, Epic, or similar is an added advantage.