Revenue Cycle Audit Specialist (Healthcare Claims)

🌟 We're Hiring: Revenue Cycle Audit Specialist (Healthcare Claims)! 🌟

The Audit Specialist supports the Audit department by auditing, submitting, monitoring, and resolving VA and Medicaid claims for Home Health, Home Health Aide, and Respite Care services. This role requires strong knowledge of insurance coverage, state-specific billing regulations, authorization requirements, and timely filing guidelines, particularly for Managed Care Organizations, including extension and reprocessing timelines. Key responsibilities include correcting claim errors, managing clearinghouse and payer rejections, resolving denials, tracking appeals and escalations, and ensuring timely and accurate reimbursement. This individual serves as a subject-matter expert for assigned payers and state billing requirements and partners with internal teams to resolve complex billing issues.

📍 Location: Ortigas Center, Philippines

⏰ Work Mode: Flexible office & remote (Hybrid)

💼 Role: Revenue Cycle Audit Specialist (Healthcare Claims)

What You'll Do:

• Audit assigned claims daily to confirm accuracy of:
• Member/patient info, DOS, units/visits, service type
• Diagnosis codes, provider identifiers, authorizations, attachments
• Validate documentation supports billed services (orders, POC, visit notes)
• Submit clean claims via clearinghouse or payer-specific processes
• Apply VA Community Care, VCA, and authorization model rules correctly
• Understand state-specific Medicaid and MCO billing requirements
• Ensure compliance with EVV, COB, eligibility, and medical necessity rules
• Interpret EOBs, RAs, and EOPs to determine next actions
• Resolve clearinghouse and payer rejections within 72 hours
• Identify root causes and correct claims end-to-end
• Prepare and track reconsiderations, appeals, and escalations
• Monitor timely filing, corrected claim, and resubmission windows
• Perform biweekly follow-ups on unadjudicated and adjudicated claims
• Run and interpret daily/weekly reports for:
• Rejections, denials, underpayments, pending claims, timely filing risks
• Maintain clear, complete audit documentation in HubSpot

What We're Looking For:

• Minimum of 2 years of experience in home health billing, audits, denials, and appeals (VA and/or Medicaid strongly preferred)
• Strong understanding of authorizations, eligibility, and payer rules
• Experience with clearinghouses, payer portals, and claim corrections
• Excellent organization, documentation, and follow-through
• Proficient in MS Office, billing/EMR systems, and reporting tools
• Proven ability to reduce denials and rejections through trend analysis

Eager to make a difference in healthcare operations? 🚀 Apply now and become part of our growing team!

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