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

Requirements

Preferred Qualifications

- Experience in handling multiple specialties (ASC, Physician Billing, Anesthesia, etc.)

- Exposure to quality frameworks (Six Sigma / Lean – good to have)

- Experience in training or coaching teams

Success Metrics (What Good Looks Like)

- High audit accuracy and consistency

- Reduction in repeat errors

- Improvement in team quality scores

- Effective feedback adoption by operations

- Measurable contribution to process improvements

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