Quality Assurance (QA) Auditor

ICBD•Lauderdale Lakes, FL

6h•Onsite

About The Position

Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. They have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With their proprietary billing process, EBS is essential to its partner healthcare companies. EBS is poised for exponential growth and is building out its teams to support the expansion of global operations. Part of the ICBD family office portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self-funded, founder-led organization. Their growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client-first innovation. The Quality Assurance (QA) Auditor will ensure operational accuracy, compliance, and performance across critical RCM functions, including Collections, Verification of Benefits (VOB), and Utilization Review (UR). The QA Auditor will conduct audits, assess adherence to standard operating procedures (SOPs), identify error trends, and collaborate with operations leadership to improve process quality, training effectiveness, and overall performance outcomes. This role is essential in safeguarding revenue integrity and operational consistency throughout the organization.

Requirements

High School Diploma or GED required
3+years of progressive experience in Revenue Cycle Management (RCM), with a focus on Collections, Verification of Benefits (VOB), and Utilization Review (UR).
Minimum of 1 year in a Quality Assurance (QA) or auditing-specific role, demonstrating the ability to identify trends and perform root-cause analysis.
Understanding of the end-to-end revenue cycle, including payer guidelines (e.g., UnitedHealthcare, Aetna, Cigna), medical necessity, and authorization requirements.
Strong ability to use Microsoft Excel (pivot tables, VLOOKUPs) to track error rates and create performance dashboards.
Solid grasp of HIPAA regulations, FDCPA (for collections), and state-specific healthcare compliance standards.
Exceptional attention to detail with the ability to manage multiple audit workstreams simultaneously while meeting strict deadlines.
Ability to deliver balanced, constructive feedback to staff and present high-level "error trend" reports to leadership.

Nice To Haves

Associate’s or Bachelor’s degree in Healthcare Administration, Health Information Management (HIM), or a related Business/Finance field

Responsibilities

Conduct routine and targeted audits related to Collections, VOB, UR, and other RCM workflows.
Evaluate staff performance against SOPs, payer guidelines, organizational standards, and compliance requirements.
Document audit findings with clear scoring, evidence-based feedback, and actionable recommendations.
Identify patterns, root causes, and error trends impacting revenue, compliance, or operational outcomes.
Verify accuracy of insurance benefit information, authorizations, and payer documentation.
Validate compliance with payer-specific utilization review requirements, timeframes, and communication standards.
Ensure collection activities follow documented workflows, legal requirements, and best practices.
Partner with department leaders and Subject Matter Experts (SMEs) to validate operational standards.
Facilitate calibration sessions to ensure consistent interpretation of scoring guidelines.
Communicate audit results constructively and supportively with staff and leadership.
Provide clarification, guidance, and process walkthroughs to reinforce adherence to quality expectations.
Recommend updates to SOPs, workflows, and job aids based on audit findings.
Support corrective action plans and retraining initiatives when performance variances are identified.
Collaborate with Training, Operations, and Process Documentation teams to ensure alignment between training content and actual system workflows.
Monitor post ‑training performance to assess skill retention and effectiveness.
Maintain precise audit records, scorecards, dashboards, and QA reports.
Track and report performance trends, error rates, and compliance risks.
Assist in developing quality metrics, scoring frameworks, and audit methodologies.
Ensure all documentation remains consistent with regulatory, payer, and organizational changes.