Role:Quality Auditor (RCM - Blended)
Experience: 36 years of hands-on RCM experience with strong understanding of multiple RCM domains & minimum 12 years in a quality/audit role preferred
Skills: Solid knowledge of US healthcare RCM, payer rules, documentation standards, and audit methodologies
Location: Muntinlupa, Philippines
We at Coforge are hiring Quality Auditor (RCM - Blended) with the following skillset:
- Perform regular quality audits across assigned RCM work types with high accuracy and attention to detail.
- Review documentation, charge entries, AR followup actions, eligibility verification details, and UM/UR determinations for correctness.
- Identify errors, trends, and root causes; provide actionable feedback to operations teams.
- Maintain quality dashboards, audit logs, and performance reports for internal and client review.
- Collaborate with operations, training, and compliance teams to improve processes and reduce recurring defects.
- Validate adherence to payer policies, coding guidelines, documentation standards, and HIPAA compliance.
- Conduct calibration sessions and participate in refresher training to ensure uniform understanding of quality standards.
- Support new hire quality audits and ongoing competency assessments.
- Recommend process enhancements aimed at improving accuracy, efficiency, and audit scores.
