RCM Quality Auditor, Payment Posting

About the Role

The RCM Quality Auditor - Payment Posting role involves reviewing the work produced by Revenue Cycle Services teams to identify and rectify errors before they impact clients financially or create compliance risks. This role requires scoring work impartially, explaining discrepancies, and contributing to the resolution of underlying issues. The specific audit focus will be determined by the auditor's background and business needs, potentially involving multiple areas.

Key Responsibilities

• Audit the work

• Run audits against the approved monthly plan, including random samples, targeted samples (e.g., high-dollar accounts, complex specialties, new payers/clients), and 100% audits for new or underperforming associates.

• Validate audited items against source documents like superbills, EMR notes, charge logs, ERAs/EOBs, and payer correspondence.

• Verify coding and charge entry details, including demographics, insurance, dates, providers, CPT/HCPCS, ICD-10-CM codes, modifiers, units, charge amounts, authorization numbers, and adherence to NCCI, MUE, and LCD/NCD requirements.

• Confirm payment posting accuracy, including billed, allowed, and paid amounts, contractual adjustments, patient responsibility, group and CARC/RARC codes, PLB adjustments, secondary claim triggers, and deposit reconciliation.

• Ensure AR and denial follow-up actions are correct, documented, and timely, with denials routed to the appropriate queues and appeals meeting payer requirements.

• Review clearinghouse rejections, scrubber edits, and auto-post exceptions, confirming timely and correct fixes.

• Identify missed, duplicate, or late charges, suspected underpayments, incorrect write-offs, and unreconciled variances, and flag gaps and leakage.

• Find the root cause and fix it

• Classify errors using the approved scoring matrix: critical/non-critical, financial/non-financial, process-based/knowledge-based.

• Provide clear, evidence-backed feedback to associates and Team Leads within 24–48 hours, tracking acknowledgment and closure.

• Conduct root cause analysis for recurring or high-impact errors, assisting in the development and tracking of corrective actions (CAPA) such as retraining, SOP updates, and checklist changes, and verifying their effectiveness.

• Participate in or lead regular calibration sessions with peers, Team Leads, operations, and client QA to ensure consistent and defensible scoring.

• Identify skill gaps from audit data, recommend refresher training, support new joiner onboarding, and maintain job aids and reference guides.

• Share payer-level patterns (e.g., denial spikes, recoupments, underpayments) with AR and Denial Management teams.

• Report, escalate and stay compliant

• Maintain complete audit logs, error trackers, feedback sheets, and calibration records, with evidence for each finding in an audit-ready structure.

• Publish daily, weekly, and monthly quality reports and scorecards at associate, team, and client levels, including RCA reports and trend charts.

• Escalate critical errors immediately, particularly those impacting revenue, compliance, or timely filing.

• Prepare quality summaries and action plans for client calls, provide data-driven answers to client quality questions with clear timelines, and submit client scorecards punctually.

• Adhere to HIPAA, PHI handling standards, CMS rules, and Veradigm information security policies.

• Track annual CPT, HCPCS, and ICD-10-CM updates and payer policy changes, flagging necessary modifications to SOPs and payer rule references.

• Help improve the process

• Identify repetitive QA tasks suitable for automation and participate in Lean, Six Sigma, and AI-assisted audit pilots.

• Support new client transitions, process documentation, and knowledge assessments.

Requirements & Tech Stack

• In-office position with shift hours Monday-Friday, 7:30 PM IST to 4:30 AM IST.
• Proficiency in auditing coding, charges, claims, payment postings, AR follow-up, and denial work.
• Familiarity with source documents such as superbills, encounter forms, EMR notes, charge logs, ERAs/EOBs, and payer correspondence.
• Understanding of NCCI, MUE, and LCD/NCD requirements.
• Knowledge of CARC/RARC codes and PLB adjustments.
• Experience with HIPAA, PHI handling standards, and CMS rules.
• Familiarity with Veradigm information security policies.
• Ability to track annual CPT, HCPCS, and ICD-10-CM updates and payer policy changes.

Qualifications

• Experience auditing Revenue Cycle Management (RCM) processes.
• Experience with quality assurance methodologies.
• Ability to explain errors clearly and identify root causes.
• Experience in providing feedback and tracking corrective actions.
• Experience with reporting and documentation.
• Experience in client support and communication.
• Experience in process improvement initiatives.

Benefits

• Quarterly Company-Wide Recharge Days
• Peer-based incentive “Cheer” awards
• Tuition Reimbursement Program