Qa Analyst - RCM

AP Management Consultants; Puducherry; On-site; INR 500,000 - 800,000; Full time

Job summary

AP Management Consultants is seeking a QA Auditor for Payment Posting processes in healthcare. You will perform daily/weekly quality audits, validate postings to patient accounts, and ensure accurate remittance handling per SOPs and HIPAA.

You will collaborate with QA and Operations, provide feedback, track errors, and assist in Root Cause Analysis while maintaining audit logs. This role emphasizes accuracy and timely reporting within a healthcare setting.

Responsibilities

• 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.

Job description

Key Responsibilities

• 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.