Audit Specialist II - CarepathRx

Accountabilities:: Coordinate and complete assigned payer audits within established deadlines and in accordance with audit program requirements. Review claim submissions for accuracy, identify discrepancies, investigate root causes, and communicate findings to leadership. Maintain up-to-date knowledge of federal and state regulations, payer guidelines, and reimbursement requirements, including Medicare, Medical Assistance, Highmark, and UPMC Health Plan. Conduct quarterly quality audits and perform quality checks for new employees until they achieve the required accuracy standards. Perform claim denial audits and ongoing quality reviews of billing and collection activities. Identify recurring errors and support employee training initiatives to improve accuracy and reduce future discrepancies. Contribute to the development and improvement of Standard Operating Procedures (SOPs). Prioritize multiple assignments, support special projects as requested, and consistently demonstrate strong professional and organizational competencies. Requirements: High school diploma or GED required. At least 3 years of experience in home infusion revenue cycle operations. Strong understanding of federal and state healthcare billing regulations and payer requirements. Proficiency in Microsoft Office Suite. Basic knowledge of medical terminology. Excellent verbal and written communication skills, with the ability to explain audit findings clearly and effectively. Strong problem-solving, analytical, and customer service skills. Excellent interpersonal and organizational abilities, with strong attention to detail and the capacity to manage multiple priorities simultaneously. Experience using CPR+ software. Familiarity with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred. For remote work, access to a cable broadband or fiber-optic internet connection with minimum speeds of 10 Mbps download and 5 Mbps upload is required. Benefits: Compensation: Anticipated hourly pay ranging from $27 to $40 USD , depending on relevant experience, qualifications, and geographic location. Annual bonus: Eligibility to participate in an annual bonus plan. Healthcare coverage: Medical, dental, and vision insurance available from the first day of employment. Well-being support: Access to behavioral health and well-being programs. Retirement planning: 401(k) savings plan. Financial protection: Company-paid life insurance. Professional development: Tuition reimbursement opportunities. Paid time off: At least 18 days of paid time off annually, in addition to paid holidays. Additional leave: Access to various leave-of-absence programs. Work flexibility: Fully remote working arrangement within the United States.