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
Solid analytical and auditing skills
Excellent knowledge of AR workflows and denial management
Ability to identify patterns and recommend improvements
Valuable 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