Job Description
Job Description
Description :
The Revenue Cycle Quality Auditor is responsible for evaluating the accuracy, compliance, and effectiveness of revenue cycle processes across multiple departments. This role ensures staff performance aligns with established workflows and standard operating procedures (SOPs) by conducting account-level audits, documenting findings, and providing constructive feedback. As risk and inefficiencies are identified, the auditor will participate in the design and implementation of solutions to drive improvement. Auditors serve as a key quality checkpoint in the revenue cycle, helping identify and address training needs, workflow gaps, and process improvement opportunities to support operational excellence.
Duties and Responsibilities
Audit and Quality Review
- Conduct monthly audits of employee work across assigned revenue cycle departments, reviewing a defined number of accounts per individual.
- Evaluate accounts against established workflows and SOPs, ensuring compliance with policies, payer requirements, and regulatory standards.
- Accurately document audit findings in Qodex tracking tool, Atlas.
- Provide timely, detailed, and constructive comments to staff regarding audit results, highlighting strengths and opportunities for improvement.
- Design and implement solutions that resolve quality issues and drive adherence to standard operating procedures.
Rebuttal & Resolution Process
Collaborate with leadership during the rebuttal review cycle to validate or adjust audit results.Defend audit scoring by referencing SOPs and applicable guidelines, while demonstrating flexibility to accept justified corrections.Address staff rebuttals by clarifying expectations and escalating discrepancies to leadership as appropriate.Partner with leadership to ensure staff understand and apply workflows consistently.Process Improvement & SOP Alignment
Identify patterns, recurring issues, and potential gaps in workflows during audit activities.Recommend updates to SOPs and collaborate with Training to ensure materials remain accurate and current.Support initiatives to improve accuracy, reduce rework, and strengthen overall compliance.Collaboration & Communication
Serve as a resource to staff, managers, and leadership on audit standards and expectations.Communicate audit outcomes clearly and professionally to support coaching and training efforts.Collaborate with cross-functional teams to ensure audit feedback informs continuous improvement efforts.Escalate systemic issues or workflow misalignments to leadership for resolution, and occasionally support implementation of issue mitigation strategies.Professional Development
Participate in ongoing training and professional development opportunities to strengthen auditing, analytical, and communication skills, including client departmental workshops.Contribute to knowledge-sharing efforts by documenting and standardizing best practices.Requirements :
1–3 years of experience in healthcare revenue cycle, quality assurance, compliance, or auditing preferred.1–3 years of experience in hospital billing operations and workflows.Strong analytical skills with attention to detail and accuracy.Proficiency in Microsoft Excel (formulas, pivot tables, charts) and other reporting tools.Clear and professional written and verbal communication skills.Ability to manage multiple priorities and deadlines in a fast-paced environment.Familiarity with EHR systems, payer guidelines, and healthcare billing standards preferred.Highly organized, with strong critical thinking and problem-solving abilities.Physical Demands and Work Environment
Work Environment : This job operates in a professional office environment with regular use of computers and phones.Physical Demands : Primarily a sedentary role with frequent keyboard, mouse, and screen use.