Audit Specialist II - CarepathRx - Remote
About The Position
The Audit Specialist II facilitates the processing of audits within the parameters of the audit program. The role reviews claim submissions for accuracy, identifies root causes of claim issues, resolves discrepancies, and shares findings with leadership. The position requires knowledge of home infusion, state and federal guidelines, and payer requirements, along with strong communication and problem-solving skills. The specialist prioritizes and completes assigned work, conducts payer and quality audits, supports training and procedure development, and completes special projects as requested. For employees working from home occasionally or permanently, internet service must be cable broadband or fiber optic with speeds of at least 10 Mbps download and 5 Mbps upload. The anticipated hourly rate is $27–$40, depending on relevant factors including experience and geographic location. The role is anticipated to be eligible for participation in an annual bonus plan.
Requirements
- High school diploma or GED.
- Proficiency in the Microsoft Office Suite.
- At least 3 years of experience in home infusion revenue cycle.
- Strong knowledge of federal and state billing guidelines.
- Working knowledge of basic medical terminology.
- Excellent verbal and written communication skills.
- Strong customer service orientation.
- Excellent problem-solving skills.
- Strong interpersonal and organizational skills, with the ability to manage multiple tasks simultaneously and maintain attention to detail.
- Experience with CPR+ Software.
Nice To Haves
- Experience with ICD-10, CPT-4, HCPCS, and Medicare billing.
Responsibilities
- Effectively prioritize and complete all assigned tasks.
- Complete payer audits in a timely manner and before deadlines.
- Maintain current knowledge of state and federal guidelines and payer requirements, including Medicare, Medical Assistance, Highmark, and UPMC Health Plan.
- Perform quarterly quality audit checks.
- Complete quality audits on new employees until the accuracy threshold is met.
- Perform claim denial audits.
- Complete ongoing quality focus audits on billing and collection activity.
- Assist with training on recurring errors identified during quality audits.
- Assist in developing Standard Operating Procedures.
- Complete special projects as requested.
- Perform in accordance with system-wide competencies and behaviors.
Benefits
- Medical benefits
- Vision benefits
- Dental benefits
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- A minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Eligibility to participate in an annual bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
