Senior RCM QA / Audit Expert

CloudRCM Solutions is seeking a highly experienced Senior QA / Audit Expert with end-to-end Revenue Cycle Management (RCM) expertise. The ideal candidate will oversee daily operations, audit the work of the billing and AR team, and ensure accuracy, compliance, and quality across all revenue cycle functions. This role focuses on identifying operational errors, revenue leakage, and process gaps while guiding the QA team to maintain high standards of performance.

Key Responsibilities:

• Perform daily audits of the operations team’s work, including billing, coding, AR follow-ups, and denial management.
• Identify errors, determine root causes, and highlight areas of revenue leakage.
• Monitor AR aging, denial trends, and key RCM metrics to ensure optimal performance.
• Provide feedback, coaching, and corrective actions to operations team members.
• Ensure compliance with standard operating procedures (SOPs), payer guidelines, and regulatory requirements.
• Prepare daily, weekly, and ad hoc QA and audit reports for management.
• Lead, manage, and mentor the QA team to ensure consistent quality and performance improvement.
• Collaborate with management to recommend process enhancements and operational efficiencies.

Requirements:

• 6+ years of end-to-end RCM experience, including billing, AR, and denial management.
• Strong QA or audit experience within a medical billing or healthcare RCM environment.
• Proven analytical and reporting skills, with the ability to interpret metrics and trends.
• Experience managing, mentoring, or guiding a team.
• Strong knowledge of payer rules, billing compliance, and revenue cycle best practices.
• Excellent attention to detail and problem-solving abilities.

Preferred Qualifications:

• CPC, CPB, or other relevant RCM certifications.
• Experience with multiple medical specialties.
• Advanced proficiency in EHR and billing software systems.

Skills & Competencies:

• Audit and compliance expertise
• Denial management and AR analysis
• Team leadership and mentoring
• Process improvement and operational optimization
• Strong reporting, documentation, and communication skills

Job Type: Full-time

Work Location: In person

Expected Start Date: 19/01/2026