Description
Role Summary
The AR Quality Auditor is responsible for evaluating the quality and accuracy of Accounts Receivable (AR) processes, identifying gaps, and driving continuous improvement across denial management, follow-ups, and resolution workflows. The role ensures adherence to client guidelines, payer protocols, and internal quality standards.

Key Responsibilities
Perform quality audits on AR workflows including:
Denial management
Insurance follow-ups
Appeals and documentation
Payment posting validation (as applicable)
Review accounts worked by AR associates and ensure:
Correct action taken based on payer guidelines
Proper documentation and notes
Accurate claim status interpretation
Identify error trends and root causes in:
Denial handling
Underpayment identification
Escalation gaps
Process deviations
Maintain and publish:
QA scorecards
Audit reports
Weekly/monthly quality dashboards
Collaborate with:
Operations teams for process improvement
Training teams for refresher sessions
Clients (if required) for quality alignment
Ensure compliance with:




HIPAA guidelines
Client SOPs
Internal quality benchmarks
Participate in calibration sessions to standardize audit decisions
Recommend and drive corrective action plans (CAPA) for low performers
Eligibility Criteria
Minimum 4+ years of experience in AR (Accounts Receivable) in US Healthcare RCM
Mandatory minimum 1 year experience as a Quality Auditor (AR QA)
Robust understanding of:
Denials (CO, PR, OA codes)
Appeals and reconsiderations
Payer-specific guidelines (Medicare, Medicaid, Commercials)
EOB/ERA analysis
Hands-on experience in:
AR calling / account resolution
Working on different billing systems / EMRs
Skills Required
Strong analytical and auditing skills
Excellent knowledge of AR workflows and denial management
Ability to identify patterns and recommend improvements
Good communication skills (written & verbal)
Proficiency in Excel (reporting, trackers, dashboards)
High attention to detail and accuracy
Re

📌 Quality Auditor, AR (Hyderabad)
🏢 Nimble Solutions
📍 Hyderabad