RCM Quality Auditor - Payment Posting

LE9220 Veradigm India Private Limited - Pune; Pune District; On-site; INR 600,000 - 1,000,000; Full time

Benefits offered by this job

Quarterly Company-Wide Recharge Days

Peer-based incentive Cheer awards

Tuition Reimbursement Program

Job summary

Veradigm is seeking a Revenue Cycle Management Quality Auditor to review the work of our RCM teams, ensuring accuracy in coding, charges, and payment postings while catching errors before they impact clients and compliance.

The role involves auditing against monthly plans, validating source documents, and providing clear, evidence-based feedback and root-cause analysis to improve processes and prevent recurrence.

Qualifications

• Attention to detail and analytical thinking required.
• Familiarity with HIPAA, PHI handling and CMS rules is beneficial.

Responsibilities

• Audit plans and random/targeted samples per monthly plan.
• Validate audited items against source documents (superbills, EMR notes, charge logs).
• Verify CPT/HCPCS, ICD-10-CM codes, modifiers, and linkage; ensure accuracy of postings and payments.
• Review denials, appeals, and payer requirements for timely resolution.
• Identify gaps, root causes, and suggest corrective actions (CAPA) and SOP updates.
• Maintain audit logs, error trackers, and prepare daily/weekly/monthly quality reports.

Job description

Working Hours

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

Position Overview

The RCM Quality Auditor Payment Posting checks the work our Revenue Cycle Services teams produce, including coding, charges, claims, payment postings, AR follow-up and denial work, and catches errors before they cost our clients money or create compliance risk. The role will score work fairly and consistently, explain clearly what went wrong and why, and help teams fix the underlying problem so it doesn't keep happening. The area you audit will depend on your background and where the business needs coverage, and you may audit more than one.

Responsibilities

• Audit plan: Run audits against the approved monthly plan, including random samples, targeted samples (high-dollar accounts, complex specialties or remits, new payers and new clients) and 100% audits for new joiners or associates on a performance improvement plan.
• Source checks: Validate each audited item against source documents such as superbills, encounter forms, EMR notes, charge logs, ERAs/EOBs and payer correspondence.
• Coding and charge entry: Verify demographics, insurance, date and place of service, rendering/billing/referring provider, CPT/HCPCS and ICD-10-CM codes and linkage, modifiers, units, charge amounts and authorisation numbers, along with NCCI, MUE and LCD/NCD requirements.
• Payment posting: Verify billed, allowed and paid amounts, contractual adjustments, patient responsibility, group and CARC/RARC codes, PLB adjustments, secondary claim triggers and deposit reconciliation.
• AR and denials: Confirm that follow-up actions are correct, documented and on time, that denials land in the right work queue, and that appeals meet payer requirements.
• Rejections and exceptions: Review clearinghouse rejections, scrubber edits and auto-post exceptions, and confirm fixes were made correctly and on time.
• Gaps and leakage: Flag missed, duplicate or late charges, suspected underpayments, incorrect write-offs and unreconciled variances. Find the root cause and fix it.
• Error classification: Classify errors using the approved scoring matrix: critical or non-critical, financial or non-financial, process-based or knowledge-based.
• Feedback: Give associates and Team Leads clear, evidence-backed feedback within 24–48 hours, and track that it is acknowledged and closed.
• 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.
• Calibration: Run or join regular calibration sessions with peer auditors, Team Leads, operations and client QA so scoring stays consistent and defensible.
• 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 denial spikes, recoupments and underpayments, with the AR and Denial Management teams.
• Records: Keep audit logs, error trackers, feedback sheets and calibration records complete, with evidence for every finding in an audit-ready file structure.
• 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.
• Client support: Prepare quality summaries and action plans for client quality calls, answer client quality questions with data and clear timelines, and submit client scorecards on time.
• Compliance: Follow HIPAA, PHI handling standards, CMS rules and Veradigm information security policies at all times, and support internal and client compliance audits.
• Staying current: Track annual CPT, HCPCS and ICD-10-CM updates and payer policy changes, and flag any needed changes to SOPs and payer rule references.
• 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.

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/

Equal Opportunity Statement

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

Thank You

Thank you for reviewing this opportunity!

Company Overview

Welcome to Veradigm, where our Mission is transforming health, insightfully. Join the Veradigm team and help solve many of today's healthcare challenges being addressed by biopharma, health plans, healthcare providers, health technology partners, and the patients they serve. At Veradigm, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders. Together, we can transform healthcare and enable smarter care for millions of people.