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)
- Strong 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
- 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 (India)
🏢 Nimble Solutions
📍 India