Audit Specialist

Eastvantage Group; Bengaluru; On-site; INR 5,814,000 - 8,721,000; Full time

Job summary

Eastvantage Group is seeking an Audit Specialist to support the Audit department by auditing, submitting, monitoring, and resolving VA and Medicaid claims for Home Health, Home Health Aide, and Respite Care services. You will help ensure compliance with state rules and timely reimbursement in a fast-paced environment.

The role requires strong problem-solving skills, attention to detail, and the ability to manage multiple priorities while meeting productivity targets.

Qualifications

• 1–3 years in home health billing, audits, denials, and appeals.
• 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.

Responsibilities

• Audit claims daily to confirm accuracy of diagnoses, provider IDs, and authorizations.
• Submit clean claims via clearinghouse or payer-specific processes.
• Apply VA Community Care, VCA, and authorization model rules correctly.
• Understand state Medicaid and MCO billing requirements.
• 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, and risks.

Skills

Home health billing

Audits

Denials

Appeals

Clearinghouses

Payer rules

Authorization rules

MS Office

EMR systems

Reporting tools

HubSpot

Tools

HubSpot

Job description

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:
• 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

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