Audit Specialist II

The Audit Specialist II is responsible for facilitating processing of audits within the parameters of the audit program. The role involves reviewing claim submissions for accuracy, identifying root causes of claim issues, with the goal of resolving discrepancies and sharing findings with leadership. The ideal candidate will have knowledge of home infusion, state and federal guidelines, and payer requirements, as well as strong communication and problem-solving skills. The position requires attention to detail, the ability to work independently, and proficiency in Microsoft 365. Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred.

Responsibilities

• Effectively prioritize and complete all assigned tasks

• Complete payer audits in a timely manner and before deadlines

• Maintain a current knowledge base of state and federal guidelines, and payer requirements, including but not limited to, Medicare, Medical Assistance, Highmark and UPMC Health Plan.

• Perform quarterly quality audit checks

• Complete quality audits on new employees until accuracy threshold is met

• Perform claim denial audits

• Complete ongoing quality focus audits on billing and collection activity

• Assist with training on recurring errors found during quality audits

• Assist in development of Standard Operating Procedures

• Complete special projects as requested

• Perform in accordance with system-wide competencies/behaviors

Skills & Abilities

• Minimum 4 years’ experience in home infusion revenue cycle

• Strong knowledge of Federal and State billing guidelines

• Working knowledge of basic medical terminology required

• Excellent verbal and written communication skills

• Strong customer service orientation

• Excellent problem-solving skills

• Strong interpersonal and organizational skills, with the ability to work on multiple tasks simultaneously with attention to detail

• Experience with CPR+ Software