Audit Specialist

Job Summary

Conducting audits of billing, documentation, insurance claims, and regulatory compliance activities, the full-time Audit Specialist will ensure adherence to Medicare, Medicaid, and commercial insurance requirements while identifying opportunities for improving reimbursement accuracy and reducing audit risk.

Key responsibilities

• Perform routine and targeted audits of patient files and billing records to ensure compliance with payer standards
• Audit submitted claims for coding accuracy and collaborate with billing staff to resolve discrepancies
• Prepare audit reports outlining findings and assist in developing policies to strengthen compliance

Required qualifications

• High school diploma or general education degree
• Minimum of 6 months of experience in healthcare auditing, medical billing, or compliance
• Experience with Medicare, Medicaid, and commercial insurance regulations
• Strong understanding of DMEPOS billing requirements and audit methodologies
• Advanced proficiency in Microsoft Excel and reporting tools