IJP - QA - Medical Billing - Payment Posting

Description

Role Summary

The Quality Auditor -Payment Posting is responsible for evaluating the quality, accuracy, and compliance of Payment Posting processes within the US Healthcare Revenue Cycle Management (RCM) environment. The role involves auditing payment posting transactions, identifying process and performance gaps, providing actionable feedback, and partnering with Operations and Training teams to drive continuous improvement. The position requires strong Payment Posting process knowledge, attention to detail, analytical ability, and the capability to make consistent and objective quality decisions.

Key Responsibilities

· Perform quality audits on Payment Posting transactions and accounts to assess accuracy, completeness, and adherence to process requirements.

· Review insurance payments, patient payments, contractual adjustments, denials, recoupments, takebacks, and other applicable transactions.

· Validate accurate posting of payments and adjustments against EOBs, ERAs, payment reports, and client-specific guidelines.

· Ensure correct handling of overpayments, underpayments, zero-payments, refunds, and unapplied payments where applicable.

· Verify accurate account allocation, adjustment codes, reason codes, payment amounts, dates, and supporting documentation.

· Evaluate adherence to client-specific SOPs, payer guidelines, internal quality standards, and compliance requirements.

· Identify and document critical and non-critical errors, process deviations, knowledge gaps, and recurring error trends.

· Provide timely and constructive feedback to Payment Posting associates.

· Conduct re-audits and validate corrective actions where required.

· Participate in quality calibration sessions to ensure consistency across auditors.

· Prepare and maintain agent scorecards, audit trackers, quality reports, error trend analysis, and weekly/monthly quality reports.

· Partner with Operations and Training teams to address recurring quality issues.

· Identify training opportunities based on audit findings and recommend refresher training.

· Support implementation of corrective and preventive action plans.

· Maintain confidentiality and ensure compliance with HIPAA and organizational policies.

Eligibility Criteria

· Minimum 4+ years of experience in US Healthcare Payment Posting/

· Minimum 1 year experience with Nimble.

· Strong understanding of Payment Posting workflows and healthcare payment transactions.

· Good knowledge of EOB/ERA interpretation, insurance payments, patient payments, contractual adjustments, denial/zero-pay transactions, and account reconciliation.

· Working knowledge of payment posting rules, adjustment codes, reason codes, and payer-specific requirements.

· Consistent performance in the current role.

· No active disciplinary action or performance-related concerns at the time of application.

· Demonstrated ability to meet productivity and quality expectations.

· Strong attention to detail and ability to make objective decisions.

Requirements

Skills Required

· Strong analytical and auditing skills.

· Excellent Payment Posting process knowledge.

· Strong attention to detail.

· Good written and verbal communication.

· Ability to identify root causes and recurring trends.

· Ability to provide constructive feedback.

· Good knowledge of MS Excel and reporting.

· Ability to work independently and manage audit volumes.

· Strong ownership and accountability.

Preferred Qualifications

· Prior experience supporting new hires or conducting process coaching.

· Experience in multiple Payment Posting workflows, specialties, or facilities.

· Exposure to various clients, calibration, or process improvement initiatives.

· Experience in trend analysis.

· Exposure to complex payment scenarios, including recoupments, takebacks, overpayments, and unapplied cash.

Success Metrics -What Good Looks Like

· Consistent and accurate audit decisions.

· High audit accuracy.

· Effective identification of Payment Posting errors.

· Reduction in repeat errors.

· Timely completion of assigned audits.

· Meaningful and actionable feedback to Operations.

· Contribution to quality improvement initiatives.

· Strong collaboration with Operations and Training