RCS Quality Auditor

Allscripts — Pune, India

Job Description Summary ​: The RCM Quality Auditor is a critical member of the Revenue Cycle Management quality assurance function, responsible for auditing end-to-end RCM processes including medical coding, claims billing, accounts receivable follow-up, denial management, and payment posting. This role ensures that all transactions meet required accuracy benchmarks, comply with HIPAA regulations, payer guidelines, and client-specific SOPs. The Quality Auditor serves as the operational backbone of quality governance — identifying defects, performing root cause analyses, supporting corrective actions, and continuously contributing to a culture of excellence across the revenue cycle. WHAT YOU’LL DO Quality Auditing Audit daily transactions across assigned RCM verticals ( billing, AR, denials, posting) against defined quality parameters Perform end-to-end internal audits covering pre-bill, post-bill, and post-payment stages of the revenue cycle Validate ICD-10, CPT, and HCPCS codes for accuracy, specificity, and payer-specific compliance rules Review claim scrubbing outputs to identify errors prior to submission and flag for correction Ensure audit sample size meets the defined monthly audit plan (100% coverage target) Process Compliance Ensure strict adherence to client-specific SOPs, payer guidelines, HIPAA, PHI, and CMS regulations Monitor and flag critical compliance errors with zero-tolerance — escalate immediately to Quality Team Leader Verify that all claim edits, modifier usage, and medical necessity documentation align with payer contracts Support internal compliance audits and provide documentation for regulatory or client reviews Error Analysis & Root Cause Analysis (RCA) Classify errors into defined categories: critical, non-critical, process, and knowledge-based Conduct root cause analysis for recurring error patterns and document findings systematically Prepare error trend analysis reports on a weekly and monthly basis to highlight systemic issues Track c

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