Audit Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the process and ensure timely responses to billing compliance audits conducted by Medicare, Medicaid, and various commercial health plans.

• Evaluate health plan reimbursement policies for coverage and documentation prerequisites.

• Examine patient file documentation for accuracy and completeness.

• Acquire and gather necessary documentation for audits.

• Initiate and address inquiries from Account Executives, operations teams, and physicians concerning necessary medical necessity documentation.

• Record and report audit inquiries, including prepayment audits, post-payment documentation requests, overpayment refund requests, medical necessity documentation, CERT audits, and other audit-related activities.

• Collaborate with internal teams and physicians to obtain additional supporting medical necessity documents.

• Assess documentation submitted for audits for completeness and accuracy.

• Notify the supervisor of any apparent issues and coordinate the submission of required documentation.

• Fill in required fields and notes in the proprietary audit application.

• Scan and upload audit requests, submissions, correspondence, findings, and results.

• Aid in tracking and reporting audit findings and results.

• Assist in implementing performance improvement initiatives related to billing and coding performance.

• Uphold the confidentiality of audit projects and related information.

⛳️ Requirements

• High School Diploma or equivalent.

• One (1) year of relevant work experience in healthcare administration, finance, insurance customer service, claims, billing, call center, or management, regardless of industry.

• For senior-level positions, a minimum of two (2) years of relevant work experience and one (1) year of direct job experience is required.

• Direct job experience encompasses the listed audit-related tasks in a Medicare-certified HME, diabetic, pharmacy, or home medical supplies environment that routinely bills insurance.

• Familiarity with Medicare, Medicaid, and commercial health plan reimbursement methodologies and documentation requirements.

• Exceptional verbal and written communication abilities.

• Strong organizational skills, attention to detail, problem-solving aptitude, and critical-thinking capabilities.

• Capacity to prioritize tasks, manage multiple projects, and work autonomously.

• Ability to adapt and function effectively in a fast-paced environment and as part of a team.

• Competence in reading and interpreting Medicare, Medicaid, and commercial health plan policy articles and procedure manuals.

• Capability to prepare routine reports and correspondence.

• Proficiency in public speaking before groups of employees.

• Aptitude for calculating figures and amounts such as discounts, interest, proportions, and percentages.

• Ability to apply basic statistical concepts.

• Capacity to use common-sense understanding to execute written, oral, or diagrammed instructions.

• Proficiency in addressing problems involving multiple concrete variables in standardized situations.

• Strong proficiency in Microsoft Office, particularly Excel, Word, and Outlook.

🏝️ Benefits

• Full-time employment.

• Remote work arrangement.