Medicaid Pre-Billing Auditor – Claims & Compliance Expert

AbleLight; Portland (OR); Vor Ort; USD 95.000 - 105.000; Vollzeit

Benefits dieser Stelle

Health Insurance

403(b) Retirement Savings Plan

Paid Time Off

Any Day Pay via Dayforce Wallet

Zusammenfassung

AbleLight is seeking an experienced Auditor/Compliance professional to review Medicaid claims, documentation, and billing accuracy. The role emphasizes risk-based audits, regulatory compliance, and cross-functional collaboration in a health services setting.

Candidates should hold a relevant degree and several healthcare auditing credentials (CPC/CCS-P/CPMA/CHC) with at least five years of experience. Competitive benefits and a focus on total well-being are offered.

Qualifikationen

• Bachelor’s degree in healthcare administration, accounting or a related field; or an equivalent combination of relevant education and experience.
• Minimum of five years of experience in auditing or a related function, including direct experience reviewing claims, coding, and supporting documentation for accuracy and regulatory compliance.
• Certifications in healthcare coding, audit, compliance, or health information (see required credentials).

Aufgaben

• Audit Medicaid claims and records, including risk-based, prospective, and retrospective reviews.
• Evaluate documentation against payer requirements and enforce billing holds when needed.
• Assess coding and billing accuracy using CPT, HCPCS, ICD-10-CM, Medicaid, waiver, managed-care, and state rules.
• Prepare and maintain audit reports with objectives, criteria, methodology, and conclusions.
• Suggest corrective actions and track progress with leadership and stakeholders.
• Collaborate with various departments to implement audit-management and analytics tools.

Kenntnisse

Auditing

Regulatory compliance

Healthcare audits

Ausbildung

Bachelor's degree

CPC

CCS-P

CPMA

CHC

Other credential

Jobbeschreibung

AbleLight is seeking an experienced Auditor/Compliance professional to review Medicaid claims, documentation, and billing accuracy. The role emphasizes risk-based audits, regulatory compliance, and cross-functional collaboration in a health services setting.

Candidates should hold a relevant degree and several healthcare auditing credentials (CPC/CCS-P/CPMA/CHC) with at least five years of experience. Competitive benefits and a focus on total well-being are offered.