Careers At HGS

Quality Auditor

Job Code : HGS/407
Cranbury |NJ Permanent

Job Description

The Quality Auditor is a performance-based position. Employees in this position will be primarily responsible for a through and timely review of the follow-up and billing work product performed by HGS teams. Reviews of work product will need to be performed to ensure actions taken on accounts are compliant and follow process. The Auditor will be responsible for providing timely feedback on the effectiveness of the process and individual. Quality Auditor does not have line authority, but acts as advisory to the Operations Manager and Team Leads in their management of Operations.



·         Recommend process improvements and updates by identifying best practices that would result in increased revenue for the client.

·         Identify and escalate payer trends (on individual and project) that would enhance productivity and quality.

·         Work on reports and assist the Operations Manager and team Leads in providing timely feedback to Accounts Receivable representatives.

·         Work with HGS leadership and management team to regulate Quality processes and enhance Quality function in the organization.

·         Assist in creating and documenting process flows that will enhance the quality of Accounts Receivable resolution.

·         Research new claim level denials and provide resolutions to reverse denials.

·         Assist Operations Manager in developing strategy formulation for clearing of backlogs and prioritizing reviews on the basis of the project’s need.

Research payer specific processes and provider manuals and develop improved billing and follow-up processes. The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned. In addition to the above, all HGS employees are expected to:

* Promote teamwork and cooperative effort. * Help train and give guidance to other HGS employees. * Maintain a clean, safe, and unobstructed work area, and practice good safety habits. * Provide internal and external customers with the highest quality service.


MINIMUM JOB REQUIREMENTS: (Education, Experience, Skills)

·         A minimum of 5 years’ hands-on experience with hospital claim billing and follow-up.

·         Understanding of revenue cycle process for healthcare providers

·         Basic Knowledge of computer and Microsoft Office, Excel, and Word

·         Excellent communication skills and telephone skills

·         Ability to research documents and find information

·         Ability to navigate through different computer systems

·         Must be flexible with the ability to adapt to changes quickly and think conceptually

·         Effective critical thinking, problem solving and decision-making skills.

·         Strong quantitative and analytical abilities to process and display data.







Customer Orientation

Agent understands the impact of individual performance as it relates to the client program and to meeting/improving targets; understands the client needs and expectations; responds to requests effectively and on time; refers complex questions to a higher decision making level; meets customer needs in a respectful, helpful and responsive manner; works with the team to meet objectives; is open to change and new information.

Communication Skills

Reads account notes and listens to insurance company representatives regarding status of accounts, and presents appropriate information in a clear and concise manner, both orally and written; able to establish two-way communication with Team Leaders.

Work Ethic

Ability to direct oneself towards meeting one’s daily, weekly and monthly goals; understands goals and works towards achieving them; asks for clarification regarding expectation about what/how things need to be done before starting work; takes ownership for work; is open to new ideas; complies with rules and processes; appropriate dress; demonstrates behaviors consistent with the organization’s values; treats others with respect; understand and follows ethical guidelines; regularly shares expertise with team members to support continuous learning and improvement; works well with others, promotes teamwork.

Job Knowledge

Demonstrates basic knowledge and ability to use various applications/tools related to the function; is aware of metric goals; has the knowledge of policies, procedures and regulatory compliance; can identify problems/issues and tries to improve this based on program knowledge; requests help to understand complex issues; identifies problems and escalates accordingly.




HGS is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.



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