Billing/Recovery Audit Specialist

About This Role

The Billing and Recovery Audit Specialist supports the Revenue Cycle, encompassing Billing, Reimbursement, and Insurance Recovery, by ensuring compliance with policies and regulations. This role involves performing quality assurance audits, identifying process improvements, and providing training to billing and recovery staff.

Responsibilities

• Update and report daily productivity metrics for billing and recovery staff
• Perform Quality Assurance (QA) Audits and identify trends on staff work
• Identify and communicate process gaps, training needs, and areas for improvement to management
• Draft weekly communications for the team based on QA audit trends and update resource manuals
• Provide group and one-on-one training to Billing and Recovery staff for new hires and ongoing development
• Facilitate and/or participate in weekly team meetings and huddles
• Work on internal charge and compliance audits, including rebilling, refunds, and follow-up
• Track and coordinate resolution of Medicare Recovery Audit Contractor (RAC) audits with Corporate Compliance
• Work on complex claims, including but not limited to BMT, CAR-T, Gene Therapy, NSA, Retro, ARUP
• Assist with Billing and Recovery work queues during high volume, staffing shortages, and complex issues

Requirements

• High school diploma or equivalent
• 3 years relevant experience

Qualifications

• High school diploma or equivalent
• 3 years relevant experience