Quality Auditor, AR

Nimble-Solutions; Hyderabad; On-site; INR 600,000 - 1,000,000; Full time

Job summary

Nimble-Solutions in Hyderabad is seeking an AR Quality Auditor to ensure the quality and accuracy of Accounts Receivable processes, with emphasis on denial management, follow-ups, and resolution workflows in line with payer guidelines and HIPAA.

You will perform audits on AR workflows, review accounts, identify error trends, maintain QA scorecards and audit reports, and collaborate with operations and training teams to drive CAPA and continuous improvement.

Qualifications

• 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 and working on different billing systems / EMRs.

Responsibilities

• Perform quality audits on AR workflows including denial management, insurance follow-ups, and appeals documentation.
• Review accounts worked by AR associates for correct actions, documentation, and accurate claim interpretation.
• Identify error trends and root causes in denials, underpayments, escalation gaps, and process deviations.
• Maintain and publish QA scorecards, audit reports, and weekly/monthly dashboards.
• Collaborate with operations, training, and clients to align quality with expectations.
• Ensure HIPAA compliance and adherence to client SOPs; participate in calibration sessions; drive CAPA.

Skills

AR workflows

Audit & QA

Data analysis

Communication

Excel reporting

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