Billing Audit & Overpayment Specialist

Equal Opportunity Employer/Disability/Veterans

Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes CGM devices, insulin pumps, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, and breast pumps. Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.

The Billing Audit Specialist is responsible for reviewing and responding to audit requests received from payers.

Duties and Responsibilities

• Review and respond to audit requests from payer appeal denial claims
• Inform necessary department of audit requirements
• Participating in training necessary departments on process changes to meet payer expectations
• Research and analyze paid health insurance claims to identify over payments
• Review benefit plans, payer contracts, fee schedules, and payment policies
• Determine root causes of over payments (e.g., duplicate payments, coordination of benefits issues, pricing errors, eligibility errors)
• Document findings clearly and maintain detailed audit trails
• Initiate and track over payment recovery activities, including offsets or refund requests
• Respond to payer inquiries and disputes related to over payment findings
• Ensure compliance with state, federal, and contractual regulations
• Identify trends and recommend process improvements to reduce future over payments
• Meet productivity, accuracy, and turnaround time standards
• Perform other duties and special projects as assigned and directed

Basic Qualifications

• 18 years of age or older
• Must be eligible to work in the United States and not require work authorization from us now or in the future
• High School diploma or equivalent required; college preferred
• At least 3 years of experience in medical billing or relevant experience

Required Skills

• Effective and professional verbal and written communication abilities
• Great customer service skills
• Professional computer experience (especially Microsoft Office Suite)
• Ability to work independently to investigate and make decisions
• Strong attention to detail
• Ability to prioritize and complete work amidst interruptions in a busy work area
• Available during normal hours of operation
• Ability to comply with guidelines both internal and industry-imposed

Competencies

• Computer Skills
• Customer Service
• Ethics
• Organization Skills
• Productivity
• Results Driven

Work Environment & Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties.

• The job requires assuming a stationary position for long periods of time

• This role routinely uses standard office equipment such as computers, phones, and printers/scanners

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This job is operated in a professional office environment

• The noise level in the work environment is usually moderate to loud

Direct Reports - None

Other Duties - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.