Quality Auditor, AR

Avontix; Hyderabad; On-site; INR 600,000 - 1,100,000; Full time

Job summary

Avontix is seeking an AR Quality Auditor to ensure accuracy and compliance across denial management, follow-ups, and resolution workflows within US Healthcare RCM. The role emphasizes adherence to client guidelines, payer protocols, and internal quality standards.

You will perform audits of AR workflows, review actions taken by associates, identify error trends, and publish QA scorecards and dashboards to drive continuous improvement, CAPA, and training needs.

Qualifications

• Minimum 4+ years of AR experience in US Healthcare RCM.
• At least 1 year as Quality Auditor (AR QA).
• Strong understanding of denials, appeals, and payer guidelines.
• Experience with HIPAA and client SOPs.
• Proficiency in Excel for reporting and dashboards.

Responsibilities

• Perform quality audits on AR workflows including denial management, follow-ups, and documentation.
• Review accounts and ensure correct actions per payer guidelines.
• Identify error trends and root causes in denials and underpayments.
• Maintain and publish QA scorecards, audit reports, and dashboards.
• Collaborate with operations, training, and clients for quality alignment.
• Participate in calibration sessions and CAPAs.

Skills

AR QA

Auditing

Denials management

Payer guidelines

Data analysis

Excel

Communication

Tools

EMR systems

Billing software

Job description

Job Type

Full-time

Description

Role Summary

The AR Quality Auditor is responsible for evaluating the quality and accuracy of Accounts Receivable (AR) processes, identifying gaps, and driving continuous improvement across denial management, follow-ups, and resolution workflows. The role ensures adherence to client guidelines, payer protocols, and internal quality standards.

Key Responsibilities

• Perform quality audits on AR workflows including:
  • Denial management
  • Insurance follow-ups
  • Appeals and documentation
  • Payment posting validation (as applicable)
• Review accounts worked by AR associates and ensure:
  • Correct action taken based on payer guidelines
  • Proper documentation and notes
  • Accurate claim status interpretation
• Identify error trends and root causes in:
  • Denial handling
  • Underpayment identification
  • Escalation gaps
  • Process deviations
• Maintain and publish:
  • QA scorecards
  • Audit reports
  • Weekly/monthly quality dashboards
• Collaborate with:
  • Operations teams for process improvement
  • Training teams for refresher sessions
  • Clients (if required) for quality alignment
• Ensure compliance with:
  • HIPAA guidelines
  • Client SOPs
  • Internal quality benchmarks
• Participate in calibration sessions to standardize audit decisions
• Recommend and drive corrective action plans (CAPA) for low performers

Eligibility Criteria

• Minimum 4+ years of experience in AR (Accounts Receivable) in US Healthcare RCM
• Mandatory minimum 1 year experience as a Quality Auditor (AR QA)
• Strong understanding of:
  • Denials (CO, PR, OA codes)
  • Appeals and reconsiderations
  • Payer-specific guidelines (Medicare, Medicaid, Commercials)
  • EOB/ERA analysis
• Hands-on experience in:
  • AR calling / account resolution
  • Working on different billing systems / EMRs

Skills Required

• Strong analytical and auditing skills
• Excellent knowledge of AR workflows and denial management
• Ability to identify patterns and recommend improvements
• Good communication skills (written verbal)
• Proficiency in Excel (reporting, trackers, dashboards)
• High attention to detail and accuracy

Requirements

Preferred Qualifications

• Experience in handling multiple specialties (ASC, Physician Billing, Anesthesia, etc.)
• Exposure to quality frameworks (Six Sigma / Lean - good to have)
• Experience in training or coaching teams

Success Metrics (What Good Looks Like)

• High audit accuracy and consistency
• Reduction in repeat errors
• Improvement in team quality scores
• Effective feedback adoption by operations
• Measurable contribution to process improvements