Medicaid Pre-Billing Auditor — Risk & Compliance

AbleLight; St. Louis (MO); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health, Dental, Vision benefits

403(b) Retirement Savings Plan with 3.

Paid Time Off (PTO)

Tuition Reimbursements

Any Day Pay via Dayforce Wallet

Job summary

AbleLight is seeking a Medicaid Pre-Billing Auditor to independently evaluate Medicaid billing, coding, authorizations, service documentation, and related reimbursement practices. The role focuses on pre-billing audits, identifying risks, and guiding remediation to reduce regulatory risk, with occasional work on commercial payer reviews as needed.

The position entails evaluating documentation for accuracy against CPT/HCPCS/ICD-10-CM and Medicaid requirements, performing risk assessments, and

Qualifications

• Bachelor’s degree in healthcare administration, accounting or related field or equivalent experience.
• Minimum of five years of auditing experience, including reviewing claims, coding, and supporting documentation for accuracy and compliance.
• Certification required: CPC, CCS-P, CPMA, CHC or other relevant healthcare credential.

Responsibilities

• Auditing and monitoring Medicaid claims and records; raise internal billing holds when necessary.
• Prepare concise audit reports, dashboards, and presentations for leadership; identify corrective actions.
• Collaborate across departments; evaluate and implement audit-management platforms and analytics tools.
• Provide subject-matter expertise on Medicaid billing, coding, documentation, and regulatory requirements.

Skills

Auditing

Regulatory compliance

Quality assurance

Education

Bachelor's degree in healthcare administration, accounting or related field

Tools

Audit software

Analytics tools

Job description

AbleLight is seeking a Medicaid Pre-Billing Auditor to independently evaluate Medicaid billing, coding, authorizations, service documentation, and related reimbursement practices. The role focuses on pre-billing audits, identifying risks, and guiding remediation to reduce regulatory risk, with occasional work on commercial payer reviews as needed.

The position entails evaluating documentation for accuracy against CPT/HCPCS/ICD-10-CM and Medicaid requirements, performing risk assessments, and