Accounts Receivable Quality Assurance Auditor at Brault

United States

$0.024k - $0.027k

<p>Description</p><p><strong>Position Summary</strong></p><p><br/></p><p>The Quality Assurance Auditor is responsible for conducting detailed audits of all billing activities and accounts worked within the billing software system. This includes reviewing claim follow-up, collections efforts, resolution of denials, and special billing projects or programs. The auditor ensures compliance with internal protocols, payer regulations, and industry standards.</p><p>This role plays a critical part in identifying trends, ensuring accuracy, and improving the overall efficiency and effectiveness of the billing and collections process.</p><p><br/></p><p><strong>Essential Duties and Responsibilities</strong></p><ul><li>Audit daily work completed by billing staff, including claim submissions, follow-up activities, and collection efforts.</li><li>Review account documentation, actions taken, and billing outcomes within the billing system to ensure accuracy, completeness, and compliance.</li><li>Identify errors, discrepancies, and trends that may impact reimbursement, operational efficiency, or regulatory compliance.</li><li>Provide detailed audit findings, feedback, and recommendations to billing staff and leadership to improve performance and accuracy.</li><li>Monitor, address, and audit special projects (e.g., credit card chargebacks and high priority payer follow up) and programs (e.g., AB75) to ensure adherence to established billing protocols.</li><li>Collaborate with team leads, supervisors, and managers to develop, implement, and refine policies, procedures, and workflows based on audit results.</li><li>Assist with the training and education of staff on documentation standards, payer requirements, billing procedures, and industry best practices.</li><li>Participate in quality assurance initiatives and prepare reports for leadership summarizing audit results, performance trends, and opportunities for improvement.</li><li>Maintain current knowledge of industry regulations, payer policies, and billing software updates applicable to medical billing and accounts receivable.</li><li>Support internal and external audit requests by gathering documentation, performing reviews, and responding to audit inquiries as needed.</li><li>Perform manual tasks within Cross Workflow, including but not limited to AR Support Requests and AR Follow-Up Requests, while addressing high-priority emails from Patient Services related to invoices involving legal representation and time-sensitive deadlines.</li><li>Conduct audits for compliance, as assigned or requested to ensure adherence to company policies, payer guidelines, and regulatory requirements.</li></ul><p><br/></p><p><strong>Other Duties</strong></p><p>Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.</p><p><br/></p><p>Requirements</p><p><strong>Knowledge, Skills, &amp; Abilities</strong></p><ul><li>Ability to work in a fast-paced environment while maintaining accuracy and focus</li><li>Strong organizational skills to ensure deadlines are met</li><li>Strong knowledge of medical billing and accounts receivable processes, including claim lifecycle, denials, and payer rules.</li><li>Proficient in using billing software and electronic health record (EHR) systems.</li><li>High attention to detail and accuracy in reviewing documentation and financial records.</li><li>Analytical skills with the ability to detect patterns, discrepancies, and areas for improvement.</li><li>Understanding and adhering to HIPAA and other government and healthcare industry regulations.</li><li>Strong written and verbal communication skills to provide constructive feedback and report findings.</li><li>Ability to work independently, manage multiple tasks, and prioritize responsibilities effectively.</li><li>Extensive knowledge of insurance guidelines including Medicare and other government payers, private, self-insurance, and managed-care plans.</li><li>Familiarity with auditing techniques and principles within a healthcare revenue cycle setting.</li><li>Knowledge of MS Office including Outlook, Word and Excel</li><li>Excellent verbal and written communication skills</li><li>Excellent attention to detail and time management skills</li><li>Excellent customer service skills.</li></ul><p><br/></p><p><strong>Education &amp; Experience Requirements</strong></p><ul><li>High School Diploma</li><li>Minimum 3-4 years revenue cycle experience</li></ul><p><br/></p>