Billing Audit & Overpayment Specialist

Reliable Respiratory•Boston, MA

7d•Onsite

About The Position

Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes CGM devices, insulin pumps, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, and breast pumps. Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible. The Billing Audit Specialist is responsible for reviewing and responding to audit requests received from payers.

Requirements

18 years of age or older
Must be eligible to work in the United States and not require work authorization from us now or in the future
High School diploma or equivalent required; college preferred
At least 3 years of experience in medical billing or relevant experience
Effective and professional verbal and written communication abilities
Great customer service skills
Professional computer experience (especially Microsoft Office Suite)
Ability to work independently to investigate and make decisions
Strong attention to detail
Ability to prioritize and complete work amidst interruptions in a busy work area
Available during normal hours of operation
Ability to comply with guidelines both internal and industry-imposed

Responsibilities

Review and respond to audit requests from payer appeal denial claims
Inform necessary department of audit requirements
Participating in training necessary departments on process changes to meet payer expectations
Research and analyze paid health insurance claims to identify overpayments
Review benefit plans, payer contracts, fee schedules, and payment policies
Determine root causes of overpayments (e.g., duplicate payments, coordination of benefits issues, pricing errors, eligibility errors)
Document findings clearly and maintain detailed audit trails
Initiate and track overpayment recovery activities, including offsets or refund requests
Respond to payer inquiries and disputes related to overpayment findings
Ensure compliance with state, federal, and contractual regulations
Identify trends and recommend process improvements to reduce future overpayments
Meet productivity, accuracy, and turnaround time standards
Perform other duties and special projects as assigned and directed