Accounts Receivable Quality Assurance Auditor

Position Overview

The Accounts Receivable Quality Assurance Auditor role involves meticulously reviewing billing activities and accounts managed within billing software. The auditor assesses claim follow-ups, collection efforts, denial resolutions, along with special billing projects or programs to assure compliance with internal standards, payer requirements, and industry regulations. This role is vital in spotting trends, verifying billing accuracy, and enhancing the efficiency of billing and collection processes.

Key Responsibilities

• Examine daily tasks performed by billing personnel, including claims submission, follow-ups, and collections.
• Audit account records, actions undertaken, and billing results in the system to validate correctness, completeness, and adherence to protocols.
• Detect errors, inconsistencies, and patterns that may affect reimbursements, compliance, or operational effectiveness.
• Deliver detailed audit reports, constructive feedback, and recommendations to staff and leadership to boost accuracy and performance.
• Oversee and audit specialized projects and programs, ensuring billing procedures are strictly followed.
• Work with team leaders and management to create and update policies, procedures, and workflows based on audit findings.
• Support training activities for staff on documentation standards, payer requirements, billing procedures, and best industry practices.
• Engage in quality assurance activities, preparing periodic performance and audit reports for leadership.
• Stay updated on relevant healthcare billing regulations, payer guidelines, and software enhancements.
• Assist during internal and external audits by compiling documentation and responding to inquiries.
• Carry out manual tasks related to accounts receivable support, addressing urgent communications involving legal invoice matters.
• Perform compliance audits to ensure all activities meet company, payer, and regulatory standards.

Additional Information

This job description is not exhaustive and duties may evolve with or without notice.

Requirements

• Ability to work accurately and efficiently in a fast-moving environment.
• Excellent organizational abilities to meet important deadlines.
• Extensive knowledge of medical billing and accounts receivable processes, encompassing claim life cycle, denials, and payer regulations.
• Proficiency with billing software and electronic health record (EHR) systems.
• Exceptional attention to detail in reviewing documentation and financial information.
• Strong analytical capabilities to identify patterns and discrepancies for improvement opportunities.
• Knowledge and compliance with HIPAA and other healthcare industry regulations.
• Effective written and oral communication skills for delivering audit feedback and reporting findings.
• Capability to work independently, multitask, and prioritize responsibilities.
• Comprehensive understanding of insurance rules including Medicare, government payers, private insurance, self-insurance, and managed care.
• Familiarity with auditing principles and methods within a healthcare revenue cycle context.
• Competency in MS Office applications such as Outlook, Word, and Excel.
• Strong customer service orientation.

Educational and Experience Qualifications

• High school diploma required.
• Minimum of three to four years of experience in revenue cycle operations.

Compensation

The position offers a salary range between $24 and $27 per hour.