Audit Specialist

Surgi-Care•Billerica, MA

2d•Onsite

About The Position

As a key member of the Revenue Cycle Management - Billing Operations team, you will play an integral role in advancing the medical technology industry by transforming patient care and improving patient outcomes. Are you detail-oriented and driven by accuracy and compliance in healthcare operations? We are seeking an Audit Specialist to support Revenue Cycle Management (RCM) audit requests and billing functions, and to collaborate with internal and external teams to resolve outstanding accounts receivable. This role is responsible for ensuring accurate charge capture, documentation, billing, and reimbursement in accordance with policies, payer guidelines, and regulatory requirements. The Audit Specialist conducts reviews of clinical documentation and billing practices, identifies opportunities to enhance compliance, and responds to third-party payer and charge recovery audits, playing a key role in protecting revenue and supporting operational excellence.

Requirements

Minimum of 5 years of experience in medical billing and collections required.
Proficiency in Microsoft Office applications required.
Knowledge of billing and collections regulations strongly preferred.
Experience in a healthcare environment strongly preferred.
Demonstrated customer service expertise.

Nice To Haves

Knowledge of insurance contract practices, third-party billing, and billing to private clients strongly preferred.
Experience using Dataworks, Computers Unlimited TIMS, or similar third-party billing software strongly preferred.

Responsibilities

Demonstrates exceptional service and integrity related to customer accounts through accurate, timely, relevant, and quality work efforts of all Accounts Receivable or assigned tasks.
Assists in the development and implementation of action plans to mitigate risk, pertaining to revenue cycle processes and billing compliance.
Review and prepare audit documentation and submit it in a timely manner to the appropriate auditing entity.
Weekly audit of insurance charges and manage AR escalations.
Analyze denial trends and provide solutions for claim adjudication.
Submit medical documentation related to the additional documentation request.
Provide feedback to billing staff on coding issues and denials.
Assist in training and education of coders and staff on compliance, billing, and coding principles for government and commercial payers.
Prepares written reports and PowerPoints of audit performance, including recommendations and data points to improve compliance billing.