The RCM Quality Auditor - AR & Denials checks the AR follow-up, denial and rejection work our Revenue Cycle Services teams produce and catches errors before they cost our clients money or create compliance risk. You will score work fairly and consistently, explain clearly what went wrong and why, and help teams fix the underlying problem so it does not keep happening.

Qualifications

- 2 to 4 years of US healthcare revenue cycle experience in AR follow-up, denial management or AR QA.
- Strong working knowledge of CARC/RARC codes, payer appeal processes, timely filing limits, and payer portal and IVR follow-up.
- Familiarity with clearinghouse rejections, scrubber edits and common front-end denial causes (eligibility, authorization, registration).
- Strong Excel skills and clear written English for feedback and client-facing summaries.
- Preferred: experience with Medicare, Medicaid and major commercial payers for multi-specialty or surgical clients, and with Veradigm practice management products.

Audit the work

- Audit plan. Run audits against the approved monthly plan, including random samples, targeted samples (high-dollar accounts, complex specialties, new payers and current clients) and 100% audits for new joiners or associates on a performance improvement plan.
- Source checks. Validate each audited account against claim history, ERAs/EOBs, payer portal and call records, and payer correspondence.
- Follow-up quality. Confirm that follow-up actions are correct, documented and on time, that account notes are clear enough for the next person to act on, and that next-action dates are set appropriately.
- Denials and appeals. Confirm that denials land in the right work queue,



that the corrective action matches the denial reason, and that appeals and reconsiderations meet payer requirements and filing limits.
- Rejections and edits. Review clearinghouse rejections and scrubber edits, and confirm fixes were made correctly and on time.
- Gaps and leakage. Flag incorrect write-offs and adjustments, missed timely filing or appeal deadlines, unworked underpayments and accounts closed without resolution.

Find the root cause and fix it

- Root cause analysis. Dig into repeat or high-impact errors, find the root cause, and help build and track corrective actions (CAPA) such as retraining, SOP updates and checklist changes. Then check that the fix worked.
- Training support. Spot skill gaps from audit data, recommend refresher training, help onboard new joiners, and keep job aids and payer reference guides current.
- Trends. Share payer-level patterns, such as denial spikes, recoupments and preventable front-end denials, with operations, AR and Denial Management leadership.

Report, escalate and stay compliant

- Reporting. Publish daily, weekly and monthly quality reports and scorecards at associate, team and client level, including RCA reports and trend charts for leadership.
- Escalation. Escalate critical errors right away, especially anything with revenue, compliance or timely filing impact.
- Staying current. Track payer policy changes, appeal and timely filing rules, and annual code updates, and flag needed changes to SOPs and payer rule references.

Help improve the process

- Automation. Point out repetitive QA tasks that could be automated, and take part in Lean, Six Sigma and AI-assisted audit pilots.
- Transitions. Support new client transitions, process documentation and knowledge assessments.

📌 RCM Quality Auditor (Pune)
🏢 Veradigm India Private
📍 Pune