Qa Analyst - RCM

Key Responsibilities

• Perform daily/weekly quality audits on Payment Posting transactions as per the defined sampling plan.

• Validate accurate posting of insurance and patient payments to the correct patient account, claim, date of

service and charge/service line.

• Verify correct posting of contractual adjustments, write-offs, denials, patient responsibility, refunds and other

adjustment transactions.

• Check accurate interpretation and application of EOBs, ERAs, remittance advices and payer correspondence.

• Validate CARC/RARC codes, adjustment reasons and denial information where applicable.

• Check handling of zero-pay, partial-pay, underpayment, overpayment and unapplied/unallocated cash

transactions.

• Identify duplicate, incorrect, incomplete or unsupported payment postings and document the errors clearly.

• Classify errors based on the approved quality framework, including critical/non-critical and financial/non-

financial impact.

• Provide timely and constructive feedback to associates and support corrective coaching.

• Participate in quality calibration sessions with QA and Operations teams to maintain consistency in evaluation.

• Track recurring errors and highlight knowledge/process gaps to the QA Lead or Operations team.

• Support Root Cause Analysis (RCA) for repeat or high-impact quality issues.

• Maintain accurate audit records, error logs and quality trackers.

• Achieve defined QA productivity, accuracy, turnaround time and audit completion targets.

• Follow client SOPs, internal quality guidelines, HIPAA/data privacy requirements and information-security

practices.