Claims Auditor, Billing Specialist
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Job Description
Claims Auditor evaluating medical billing processes and conducting front-end audits while working remotely. Ensuring compliance with payer requirements and collaborating with internal teams effectively.
Responsibilities:
- Conduct front-end audits of claims prior to submission to identify errors, inconsistencies, or missing information
- Review documentation, scheduling data, authorizations, and payer requirements to research and resolve discrepancies
- Communicate with providers and internal teams to verify services delivered and ensure accurate claim representation
- Make corrections and updates within the practice management system to produce clean, submission-ready claims
- Apply payer-specific and state-specific billing rules to ensure compliance and minimize denials
- Interpret and apply billing regulations to resolve new or complex scenarios effectively
- Review Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), and bank deposits to accurately post payments
- Reconcile posted payments against deposit totals and investigate discrepancies or underpayments
- Identify and escalate payer trends, issues, or inconsistencies
- Generate and update patient invoices as needed
- Follow up with patients or responsible parties on outstanding balances
- Document all communication attempts and payment arrangements
- Support timely resolution of accounts receivable to improve overall financial performance
Requirements:
- Experience with medical billing, claims auditing, or revenue cycle management
- Strong understanding of payer requirements, billing compliance, and claims processes
- Ability to interpret and apply billing rules across multiple payers and states
- Experience reviewing EOBs/ERAs and posting payments accurately
- Proven ability to reconcile payments and identify discrepancies
- Strong attention to detail and problem-solving skills
- Excellent communication skills for collaborating with providers and internal teams
- Ability to work independently and manage high-volume workflows
Benefits:
- Comfortable working U.S. hours
- Remote work from home
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