Remote Quality Auditor (Hospital Billing & Professional Billing)

The Quality Auditor is responsible for reviewing and auditing healthcare billing, claims processing, insurance follow-up activities, and denial management workflows to ensure compliance, accuracy, and reimbursement optimization. This remote position supports quality assurance initiatives across hospital billing (HB) and professional billing (PB) operations.

This Remote Quality Auditor role fits best as a low-phone healthcare administration position. While communication with operations teams, leadership, and stakeholders is required, the majority of daily responsibilities involve auditing accounts, reviewing documentation, validating billing activities, analyzing denials, and identifying opportunities for process improvement.

Daily responsibilities include conducting end-to-end audits of hospital and professional billing accounts, reviewing technical denials such as eligibility issues, duplicate claims, authorization problems, timely filing denials, provider-related denials, and demographic errors. The auditor also reviews clinical denials involving medical necessity, diagnosis and procedure relationships, level of care determinations, documentation issues, and non-covered services.

The role includes evaluating insurance follow-up activities, appeals handling, underpayment investigations, Workers’ Compensation claims, Third-Party Liability workflows, and coordination of benefits processes. Team members perform root cause analysis to identify denial trends, quality concerns, operational risks, and reimbursement opportunities.

Additional responsibilities include tracking defect patterns, maintaining audit consistency, participating in calibration sessions, providing feedback to operational teams, and supporting denial prevention initiatives. Strong analytical thinking, attention to detail, and process improvement skills are essential for success.

Candidates with experience in healthcare revenue cycle management, medical billing, claims auditing, denial management, quality assurance, insurance follow-up, compliance review, healthcare operations, or reimbursement services may align well with this opportunity. Familiarity with CPT coding, ICD-10 coding, payer guidelines, billing workflows, and healthcare regulations is strongly preferred.

Overall, this position offers an excellent opportunity for experienced healthcare auditing professionals who enjoy quality assurance, compliance analysis, denial research, process improvement, and data-driven operational excellence in a remote environment.