Quality Auditor, AR

Nimble; Hyderabad; On-site; INR 700,000 - 1,100,000; Full time

Job summary

Nimble is seeking an AR Quality Auditor in Hyderabad to ensure accuracy of Accounts Receivable processes for US Healthcare RCM. You will audit denial management, follow-ups, appeals, and payment postings, and drive improvements with operations and training teams.

The role emphasizes HIPAA compliance, proper documentation, and adherence to payer guidelines. You will publish QA scorecards and dashboards, calibrate audit decisions, and support CAPA initiatives across multiple specialties.

Qualifications

• Minimum 4+ years of AR experience in US Healthcare RCM.
• Mandatory 1 year as a Quality Auditor (AR QA).
• Strong knowledge of denials, appeals, and payer guidelines.
• Hands-on experience with AR calling and EMR/billing systems.

Responsibilities

• Perform quality audits on AR workflows including denial management and insurance follow-ups.
• Review accounts handled by AR staff for accuracy and documentation.
• Identify error trends and root causes in denials and underpayments.
• Maintain and publish QA scorecards, audit reports, and dashboards.
• Collaborate with Operations and Training teams for process improvements.
• Ensure HIPAA compliance and alignment with client SOPs.
• Participate in calibration sessions to standardize audit decisions.
• Recommend CAPA actions for underperformers.

Skills

Analytical skills

Auditing skills

AR workflows

Denial management

Communication skills

Excel proficiency

Attention to detail

Tools

EMRs

Billing systems

Job description

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
• 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