Quality Expert

Key Responsibilities:
Audit AR processes including follow-ups, denials, appeals, and collections
Review work for accuracy, compliance, and adherence to payer guidelines
Analyze denial trends, aging reports, and identify root causes
Monitor insurance calling quality and documentation standards
Ensure timely and accurate claim resolution as per SLAs
Conduct root cause analysis (RCA) and recommend corrective actions
Provide structured feedback, coaching, and mentoring to AR teams
Participate in calibration sessions and quality audits
Prepare and share quality reports and insights with stakeholders
Drive continuous improvement initiatives across AR processes

Qualification:
Graduate from any discipline

Required Skills:
3+ years of experience in US Healthcare RCM – AR Quality/Audit
Strong understanding of AR lifecycle, denials, and appeals
Knowledge of payer guidelines and insurance workflows
Good analytical and problem-solving skills
Strong communication (verbal & written) skills
Experience in US payer calling and portals
Proficiency in MS Excel and reporting tools