Audit Specialist II - CarepathRx - Remote

The Audit Specialist II is responsible for facilitating processing of audits within the parameters of the audit program. The role involves reviewing claim submissions for accuracy, identifying root causes of claim issues, with the goal of resolving discrepancies and sharing findings with leadership. The ideal candidate will have knowledge of home infusion, state and federal guidelines, and payer requirements, as well as strong communication and problem-solving skills. What you'll do to make a difference: Effectively prioritize and complete all assigned tasks Complete payer audits in a timely manner and before deadlines Maintain a current knowledge base of state and federal guidelines, and payer requirements, including but not limited to, Medicare, Medical Assistance, Highmark and UPMC Health Plan Perform quarterly quality audit checks Complete quality audits on new employees until accuracy threshold is met Perform claim denial audits Complete ongoing quality focus audits on billing and collection activity Assist with training on recurring errors found during quality audits Assist in development of Standard Operating Procedures Complete special projects as requested Perform in accordance with system-wide competencies/behaviors What you need to be successful: High School diploma or GED required Proficiency in the Microsoft Office Suite 3+ years of experience in home infusion revenue cycle Strong knowledge of Federal and State billing guidelines Working knowledge of basic medica