Medicaid Pre-Billing Auditor

Put Your Heart to Work! At AbleLight we believe theworldshinesbrighterwhen people with developmental disabilities achieve their full potential. We pioneer life-changing services that empower the people we serve to Medicaid Pre-Billing Auditor independently evaluates Medicaid billing coding authorizations service documentation and related reimbursement practices to determine whether claims are accurate properly coded and compliant with federal and state requirements. A primary focus will be pre-billing audits. The role identifies billing risks imposes billing holds before defective billing is initiated recommends corrective actions and monitors remediation to reduce regulatory risk. Limited reviews involving commercial payers may also be performed based on organizational degree in healthcare administration accounting or a related field; or an equivalent combination of relevant education and of five years of experience in auditing or a related function including direct experience reviewing claims coding and supporting documentation for accuracy and regulatory of the following:Certified Professional Coder (CPC) through AAPC; orCertified Coding SpecialistPhysician-based (CCS-P) through AHIMA; orCertified Professional Medical Auditor (CPMA); orCertified in Healthcare Compliance (CHC); orAnother relevant healthcare coding audit compliance or health information credentialBenefits: We support the whole person and have designed our benefits with you and your familys total well-being in mind:Health and Wellness: Medical Dental and Vision benefits starting the first of the month following 30 days of employmentand access to Teledoc Financial Wellness: 403(b) Retirement Savings Plan with 3.5% matching contributions Health Savings Account Flexible Savings Account and Basic Life AD&D STD and LTD insurance Work/Life Balance: Paid Time Off (PTO) Tuition Reimbursements Trainingprogram will allow you to become CPR certified Ongoing training to support Career DevelopmentWe are now also offering Any Day Pay. With Dayforce Wallet you get access to your pay as soon as youve earned it at no additional cost to : Auditing and Monitoring (70%)Conduct risk-based prospective and retrospective audits of Medicaid claims and whether documentation meets payer requirements. Impose internal billing holds where pre-billing audits find documentation does not meet billing coding and billing accuracy using applicable CPT HCPCS ICD-10-CM Medicaid program waiver managed-care and state-specific billing-related risk assessments investigations payer audits government inquiries and compliance reviews as escalate suspected overpayments and other significant concerns in accordance with organization and Corrective Action (10%)Maintain complete and defensible audit reports documenting audit objectives criteria methodology samples evidence reviewed exceptions conclusions and reviewer findings to identify patterns control weaknesses potential financial exposure and opportunities for process concise written reports dashboards and presentations that communicate findings and recommended actions to Compliance leadership and appropriate practical corrective actions and collaborate with accountable leaders to establish responsibilities target dates and validation corrective-action progress perform follow-up testing and determine whether remediation is effective and records of findings corrective actions management responses and closure -Functional Collaboration and Audit Technology (10%)Work collaboratively with various departments while preserving the objectivity of the Compliance audit evaluate and implement audit-management platforms compliance-monitoring software analytics tools dashboards and automated exception-reporting approved data analytics and AI-assisted auditing technologies to analyze claims and documentation identify outliers prioritize higher-risk records recognize recurring patterns and expand audit and Regulatory Support (10%)Serve as a subject-matter resource on Medicaid billing coding documentation reimbursement and audit relevant Medicaid billing manuals waiver requirements regulatory updates payer guidance coding changes and enforcement education needs arising from audit results and provide content expertise to various with the development or revision of organization policies and procedures

Required Experience:

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