Provider Audit Specialist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Provider Audit Specialist responsible for auditing hospital charge data and claims. Collaborating with internal teams to ensure billing compliance and recommend improvements.
Responsibilities:
- Conduct end-to-end audits of provider charge masters (CDM) and associated claims to evaluate billing accuracy, rate structures, and adherence to contractual and regulatory requirements.
- Review and analyze provider chargemaster data to identify outliers, inconsistencies, or policy violations.
- Assist in the development and maintenance of audit models, dashboards, and templates to support enterprise audit functions.
- Prepare audit summaries with findings and recommendations.
- Support provider communications regarding audit findings and recommend process improvements.
- Maintain current knowledge of CMS guidelines, payer policies, and healthcare billing standards (UB-04, CPT, HCPCS, revenue codes).
- Contribute to reimbursement and contract review projects.
Requirements:
- 2-4 years in provider auditing, revenue integrity, hospital billing, or charge master analysis
- Proficiency in Microsoft Office Suite products (Access, Excel, Word, PowerPoint, etc.), SAS, SQL, PowerBI, or other software used for both analytic, reporting, and data visualization functions.
- Knowledge of CPT/HCPCS coding, CMS billing guidelines, and provider reimbursement methodologies.
- Bachelor’s degree in healthcare administration, Health Information Management, Accounting, or related field.
- Preferred certifications: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA).
Benefits:
- Professional development opportunities
- Flexible working arrangements
Similar Jobs
IT Specialist
IT Specialist providing key technical support and management for Eduphoria’s remote workforce. Ensure secure access to tools and resources for educators.
IT Manager
IT Manager responsible for leading Information Technology vision and strategy for Stewart, managing IT teams and ensuring departmental goals are met.
Level 1 Help Desk Technician
Level 1 Help Desk Technician providing first-line IT support for Auctus Group's healthcare technology. Responsible for troubleshooting and resolving technical issues for internal teams across multiple departments.
2nd Line IT Support, Project Engineer
2nd Line Support Engineer providing escalated technical support across multiple regions for a global MSP. Assisting clients in North and South America with complex incidents and service requests.
Claims Compliance Audit Specialist
Claims Compliance Audit Specialist at Kin reviewing claims for accuracy and compliance with regulatory requirements. Collaborating with claims and legal teams to improve operational effectiveness.
Senior Enterprise Architect – CLM, Spend Management
Senior Enterprise Architect at Workday guiding customers in AI-augmented contract workflows. Leading strategic technology solutions in Spend Management and CLM.
People Systems Support Specialist
HR Systems Support Specialist supporting HR operations and technology solutions at Wella, including SAP SuccessFactors. Responsible for user support, troubleshooting, and system administration activities.
Audit Manager
Audit Manager for RRBB Accountants + Advisors leading attest engagements and mentoring staff. Ensuring compliance with accounting standards and providing quality assurance in audits and reviews.
IT Help Desk Specialist
IT Help Desk Specialist providing Tier 1-2 support for a remote workforce at TopDog Law. Managing tickets and troubleshooting hardware and software issues in a fast-paced environment.
Help Desk Representative
Provide Tier 1 customer support for health insurance inquiries via phone, chat, and email. Remote work position located within the United States, focusing on agents and state agencies.
Principal Enterprise Architect
Principal Enterprise Architect defining and governing enterprise-wide architecture strategy at IQVIA. Collaborating with business and technology leaders to optimize clinical operations.
IT Help Desk
IT Help Desk role ensuring operational productivity for Addi employees with secure technology infrastructure management. Maintaining a high ticket resolution rate and automating processes for improved efficiency.
IT Manager
IT Manager leading a small team at Longbow Advantage, a B2B SaaS logistics company. Responsible for critical IT functions and operational maturity within the organization.
Pharmacy Benefit Technician
Pharmacy Benefit Technician handling calls regarding pharmacy issues and prior authorizations. Responsible for processing requests and serving as a liaison with pharmacy benefit managers.
Corporate IT Support Specialist
Corporate IT Support Specialist providing first line support for Vultr's remote teams managing IT ticketing and SaaS administration
Enterprise Architect
Enterprise Architect leading multiple complex projects using in-depth domain knowledge at GE Vernova. Contributing to technology development, architecture design, and project management.
Enterprise Architect
Enterprise Architect leading highly complex projects that require in-depth domain knowledge. Focusing on project and data delivery platforms and future architecture direction.
Senior IT Engineer – MSP
Senior IT Engineer providing expert support across systems, servers, and cloud environments. Collaborating with clients and mentoring junior engineers in a fully remote setup.
Technical Customer Support Specialist
Technical Customer Support Specialist providing support for Bold Group's Financial Management solutions. Monitoring ticketing queues and solving technical issues for customers in diverse environments.
IT Manager
IT Manager overseeing daily IT operations for government contracting organization in cloud environment. Responsible for user support, compliance, and endpoint management.