Quality Auditor

Job Summary

To ensure accuracy and compliance in billing processes, the remote Quality Auditor will conduct audits of Hospital Billing (HB) and Professional Billing (PB) accounts, focusing on technical and clinical denials, insurance follow-up workflows, and Workers' Compensation (WC) and Third-Party Liability (TPL) processes.

Key responsibilities

• Perform end-to-end audits of HB and PB accounts, including billing, denials, and accounts receivable follow-up activities
• Review and validate technical and clinical denials, ensuring compliance with payer guidelines and regulations
• Conduct root cause analysis and provide actionable feedback to operations teams to support process improvement initiatives

Required qualifications

• Bachelor's degree preferred, ideally in Healthcare or Revenue Cycle Management (RCM)
• Certifications such as AAPC (CPC/COC) or AHIMA are preferred
• 5+ years of experience in Revenue Cycle Management (RCM) with strong exposure to Hospital and Professional Billing
• Experience in denials management, insurance follow-up, and audit/QA activities
• Strong understanding of payer guidelines, CPT, ICD-10, and denial workflows