Accounts Receivable Quality Assurance Auditor

Position Overview

The Accounts Receivable Quality Assurance Auditor is tasked with performing comprehensive audits of billing processes and accounts within the billing software. This position encompasses reviewing claims follow-up, collection procedures, addressing denials, and overseeing specialized billing assignments or programs. The auditor's role is pivotal in ensuring adherence to internal guidelines, payer mandates, and industry regulations.

Key Responsibilities

• Examine the daily outputs of billing personnel, including submissions, follow-ups, and collection activities.
• Assess account files, actions documented, and billing results to verify precision, completeness, and regulatory compliance within the billing system.
• Detect inconsistencies, errors, and patterns that could affect reimbursements, operational workflows, or compliance adherence.
• Deliver comprehensive audit reports with constructive feedback and suggestions to billing teams and management to enhance accuracy and performance.
• Oversee and audit special initiatives, such as credit card chargebacks and critical payer follow-ups, and programs like AB75, ensuring they align with prescribed billing practices.
• Work collaboratively with team leaders and managers to devise, update, and optimize policies and procedures informed by audit findings.
• Support staff learning by providing training related to documentation protocols, payer stipulations, billing processes, and industry standards.
• Engage in quality assurance projects and compile reports reflecting audit outcomes, trends, and improvement areas for leadership review.
• Stay informed on evolving industry regulations, payer policies, and billing software enhancements affecting medical billing and receivables.
• Assist in both internal and external audit processes by compiling relevant documentation, conducting reviews, and responding to inquiries.
• Carry out manual operations within Cross Workflow, including handling AR Support and Follow-Up Requests, while managing urgent communications from Patient Services about invoicing issues involving legal matters and strict deadlines.
• Perform designated compliance audits to ensure policies and regulatory mandates are consistently followed.

Additional Information

The job description provides a general overview and is not exhaustive; duties may evolve with or without notice to meet organizational needs.

Qualifications & Skills

• Proven ability to maintain accuracy under high volume and fast-paced environments.
• Excellent organizational skills to ensure timely completion of tasks.
• In-depth understanding of medical billing, accounts receivable workflows, claim processing, denials, and payer regulations.
• Experience with billing software and electronic health record (EHR) systems.
• Meticulous attention to detail in reviewing financial and documentation records.
• Strong analytical aptitude to identify trends, discrepancies, and potential enhancements.
• Knowledgeable about HIPAA and other relevant healthcare laws and regulations.
• Effective written and oral communication capabilities for delivering feedback and audit findings.
• Self-motivated with the ability to multitask, prioritize, and work independently.
• Comprehensive familiarity with insurance processes including Medicare, government payers, private/self-insurance, and managed care plans.
• Understanding of auditing techniques relevant to healthcare revenue cycles.
• Proficiency in Microsoft Office suite, including Outlook, Word, and Excel.
• Strong customer service orientation and excellent time management.

Education & Experience

• High school diploma required.
• At least 3 to 4 years of experience in revenue cycle management or similar roles.

Compensation

The salary range for this position is from $24.00 to $27.00 per hour.