- Perform daily/weekly quality audits on Payment Posting transactions as per the defined sampling plan.
- Validate accurate posting of insurance and patient payments to the correct patient account, claim, date of service and charge/service line.
- Verify correct posting of contractual adjustments, write-offs, denials, patient responsibility, refunds and other adjustment transactions.
- Check accurate interpretation and application of EOBs, ERAs, remittance advices and payer correspondence.
- Validate CARC/RARC codes, adjustment reasons and denial information where applicable.
- Check handling of zero-pay, partial-pay, underpayment, overpayment and unapplied/unallocated cash transactions.
- Identify duplicate, incorrect, incomplete or unsupported payment postings and document the errors clearly.
- Classify errors based on the approved quality framework,
including critical/non-critical and financial/non-
financial impact.
- Provide timely and constructive feedback to associates and support corrective coaching.
- Participate in quality calibration sessions with QA and Operations teams to maintain consistency in evaluation.
- Track recurring errors and highlight knowledge/process gaps to the QA Lead or Operations team.
- Support Root Cause Analysis (RCA) for repeat or high-impact quality issues.
- Maintain accurate audit records, error logs and quality trackers.
- Achieve defined QA productivity, accuracy, turnaround time and audit completion targets.
- Follow client SOPs, internal quality guidelines, HIPAA/data privacy requirements and information-security practices.