Audit Specialist II

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

📋 Description

• Facilitate the execution of audits within the established framework of the audit program

• Assess claim submissions for precision

• Determine root causes of claim discrepancies

• Address inconsistencies and communicate findings with leadership

• Organize and finalize assigned responsibilities

• Complete payer audits ahead of deadlines

• Stay informed about state and federal regulations and payer requirements, including Medicare, Medical Assistance, Highmark, and UPMC Health Plan

• Conduct quarterly quality audit assessments

• Audit new hires until they achieve the accuracy benchmark

• Execute claim denial audits

• Carry out continuous quality focus audits on billing and collections

• Support training initiatives addressing recurring errors identified during quality audits

• Contribute to the creation of Standard Operating Procedures

• Undertake special projects as assigned

• Operate in alignment with system-wide competencies and behaviors

⛳️ Requirements

• High School diploma or GED is mandatory

• Proficiency in Microsoft Office Suite is required

• 3+ years of experience in home infusion revenue cycle

• Strong understanding of Federal and State billing regulations

• Basic medical terminology knowledge is essential

• Outstanding verbal and written communication abilities

• Robust customer service orientation

• Excellent problem-solving capabilities

• Strong interpersonal and organizational skills, with the capacity to manage multiple tasks simultaneously while maintaining attention to detail

• Familiarity with CPR+ Software is advantageous

• Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred

• Home internet connection via cable broadband or fiber optic service with a minimum of 10Mbps download and 5Mbps upload speed is required for remote work

• Candidates in eligible states who use tobacco/nicotine must enroll in a qualifying smoking cessation program before starting employment

🏝️ Benefits

• Eligibility for an annual bonus plan

• Medical, vision, and dental insurance coverage

• Access to well-being and behavioral health programs

• 401(k) retirement plan

• Company-sponsored life insurance

• Tuition reimbursement opportunities

• A minimum of 18 days of paid time off annually

• Paid holidays

• Leave of absence options

• Implementation of a tobacco-free policy