In Office - Shift Hours M-F 730pm IST to 430am IST
The RCM Quality Auditor checks the work our Revenue Cycle Services teams produce, including coding, charges, claims, payment postings, AR follow-up and denial work, and catches errors before they cost our clients money or create compliance risk.
The role will score work fairly and consistently, explain clearly what went wrong and why, and help teams fix the underlying problem so it doesn't keep happening. The area you audit will depend on your background and where the business needs coverage, and you may audit more than one.
Audit the work
• Audit plan: Run audits against the approved monthly plan, including random samples, targeted samples (high-dollar accounts, complex specialties or remits, new payers and new clients) and 100% audits for recent joiners or associates on a performance improvement plan.
• Source checks: Validate each audited item against source documents such as superbills, encounter forms, EMR notes, charge logs, ERAs/EOBs and payer correspondence.
• Coding and charge entry: Verify demographics, insurance,
date and place of service, rendering/billing/referring provider, CPT/HCPCS and ICD-10-CM codes and linkage, modifiers, units, charge amounts and authorisation numbers, along with NCCI, MUE and LCD/NCD requirements.
• Payment posting: Verify billed, allowed and paid amounts, contractual adjustments, patient responsibility, group and CARC/RARC codes, PLB adjustments, secondary claim triggers and deposit reconciliation.
• AR and denials: Confirm that follow-up actions are correct, documented and on time, that denials land in the right work queue, and that appeals meet payer requirements.
• Rejections and exceptions: Review clearinghouse rejections, scrubber edits and auto-post exceptions, and confirm fixes were made correctly and on time.
• Gaps and leakage: Flag missed, duplicate or late charges, suspected underpayments, incorrect write-offs and unreconciled variances.
Find the root cause and
📌 RCM Quality Auditor (Pune)
🏢 Veradigm
📍 Pune