Audit Specialist

Were Hiring: Audit Specialist!

• Job Location - Bangalore, BTM Layout
• 5 days working from office in USA Shift timings
• The Audit Specialist supports the Audit department by auditing, submitting, monitoring, and resolving VA
• and Medicaid claims for Home Health, Home Health Aide, and Respite Care services. This role requires
• strong knowledge of insurance coverage, state-specific billing regulations, authorization requirements,
• and timely filing guidelines, particularly for Managed Care Organizations, including extension and
• reprocessing timelines. Key responsibilities include correcting claim errors, managing clearinghouse and
• payer rejections, resolving denials, tracking appeals and escalations, and ensuring timely and accurate
• reimbursement. This individual serves as a subject-matter expert for assigned payers and state billing
• requirements and partners with internal teams to resolve complex billing issues.
• This position also requires the ability to interpret EOBs, remittances, and EOPs to determine appropriate
• next steps, even without direct access to payer portals. The ideal candidate is a proactive problem-solver
• who can develop and communicate solutions, write clear provider summaries, and share knowledge by
• teaching and supporting the team. Strong attention to detail, disciplined follow-through, flexibility, and the
• ability to manage multiple priorities while meeting daily productivity standards are essential. The
• specialist serves as a key point of contact for provider escalations and ensures accurate tracking and
• documentation in HubSpot. This position reports to the Audit Manager.

Core Responsibilities:

• Audit assigned claims daily to confirm accuracy of:
• Member/patient info, DOS, units/visits, service type
• Diagnosis codes, provider identifiers, authorizations, attachments
• Validate documentation supports billed services (orders, POC, visit notes)
• Submit clean claims via clearinghouse or payer-specific processes
• Apply VA Community Care, VCA, and authorization model rules correctly
• Understand state-specific Medicaid and MCO billing requirements
• Ensure compliance with EVV, COB, eligibility, and medical necessity rules
• Interpret EOBs, RAs, and EOPs to determine next actions
• Resolve clearinghouse and payer rejections within 72 hours
• Identify root causes and correct claims end-to-end
• Prepare and track reconsiderations, appeals, and escalations
• Monitor timely filing, corrected claim, and resubmission windows
• Perform biweekly follow-ups on unadjudicated and adjudicated claims
• Run and interpret daily/weekly reports for:
• Rejections, denials, underpayments, pending claims, timely filing risks
• Maintain clear, complete audit documentation in HubSpot
  

Experience and Skills:

• Minimum of 1-3 years of experience in home health billing, audits, denials, and appeals (VA
  and/or Medicaid strongly preferred)
• Strong understanding of authorizations, eligibility, and payer rules
• Experience with clearinghouses, payer portals, and claim corrections
• Excellent organization, documentation, and follow-through
• Proficient in MS Office, billing/EMR systems, and reporting tools
• Proven ability to reduce denials and rejections through trend analysis