RCM Quality Auditor - Payment Posting

In office - Shift hours M-F 730pm IST to 430am IST

About the role

The RCM Quality Auditor - Payment Posting checks the payment posting 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.

Suggested qualifications

• 2 to 4 years of US healthcare revenue cycle experience in payment posting or posting QA.

• Strong working knowledge of ERA 835 remits, EOBs, group and CARC/RARC codes, PLB adjustments and coordination of benefits.

• Experience with deposit and batch reconciliation and unapplied cash resolution.

• Strong Excel skills and clear written English for feedback and client-facing summaries.

• Preferred: experience with Veradigm practice management products and with multi-specialty or surgical clients.

Audit the work

• Audit plan. Run audits against the approved monthly plan, including random samples, targeted samples (high-dollar payments, complex remits, new payers and new clients) and 100% audits for new joiners or associates on a performance improvement plan.

• Source checks. Validate each audited posting against ERAs, EOBs, lockbox images, deposit records and payer correspondence.

• Posting accuracy. Verify billed, allowed and paid amounts, contractual adjustments, patient responsibility, group and CARC/RARC codes, and PLB adjustments.

• Downstream triggers. Confirm secondary and tertiary claims were triggered correctly, denials posted with zero pay were routed to the right work queue, and patient balances transferred correctly.

• Exceptions and unapplied cash. Review auto-post exceptions, unapplied and suspense balances, and confirm they were resolved correctly and on time.

• Deposit reconciliation. Confirm posted totals reconcile to bank deposits and batch totals, and flag unreconciled variances.

• Gaps and leakage. Flag suspected underpayments, incorrect write-offs and adjustments, duplicate postings, and credit balances created by posting errors.

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, adjustment code mapping changes 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 reference guides current.

• Trends. Share payer-level patterns, such as underpayments, recoupments, takebacks and recurring denial codes, with the AR and Denial Management teams.

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 patient billing impact.

• Staying current. Track CARC/RARC code updates and payer policy and remit format changes, and flag needed changes to SOPs and payer rule references.

Help improve the process

• Automation. Point out repetitive QA tasks and auto-posting rules that could be automated or improved, and take part in Lean, Six Sigma and AI-assisted audit pilots.

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

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish. 

• Quarterly Company-Wide Recharge Days

• Peer-based incentive “Cheer” awards

• Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/ 

https://veradigm.com/about-veradigm/careers/culture/ 

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Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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