Payer Audit Specialist – Flexible Schedule & RCM Excellence

BrightSpring Health Services; United States; Remote; USD 28,000 - 29,000; Full time

Benefits offered by this job

Health, Dental, Vision & Life

Company-Paid Short & Long-Term Disable

Flexible schedules & Paid Time Off

Tuition Reimbursement

Employee Discount & DailyPay

401k

Pet Insurance

Job summary

PharMerica, an affiliate of BrightSpring Health Services, seeks a Payer Audit Specialist to manage payer audit requests, compile documentation, and respond within deadlines. The role supports Medicare, Medicaid, and commercial payers while ensuring compliance and quality assurance across billing records.

Responsibilities include coordinating across departments, analyzing audit trends, and maintaining accuracy in medical documentation and responses.

Qualifications

• High School diploma/GED or equivalent; some college a plus.
• 2–4 years in revenue cycle management with knowledge of Managed Care, Commercial, Government, Medicare, and Medicaid; audit experience a plus.
• Experience with automated billing systems; CPR+ and Waystar a plus.
• Knowledge of ICD-9/10, CPT, HCPCS coding, and medical terminology; strong MS Office skills and 40+ WPM typing.
• Strong verbal and written communication; ability to obtain and interpret information and compose audit responses.
• Strong attention to detail; flexible and able to adapt to workflow volumes.
• Knowledge of federal and state regulations as it pertains to revenue cycle management; a plus.
• Flexible schedule with the ability to work evenings, weekends, and holidays as needed.

Responsibilities

• Receives, documents, processes, and tracks all incoming payer audit requests and updates until final resolution.
• Adheres to all applicable state/federal regulations and company policies.
• Communicates and coordinates across departments to ensure audits receive proper review, appeals, and resolution.
• Coordinates with other departments to obtain documentation and justification for medical services rendered; assembles documentation and submits to payers in required format.
• Responds timely to payer audit requests and submits responses within deadlines.
• Analyzes payer audit trends and communicates concerns and process improvement needs to RCM Ancillary Services management.
• Works within established departmental goals and performance/productivity metrics.

Skills

Communication skills

Attention to detail

Multi-tasking

Problem solving

Analytical thinking

Education

High School diploma/GED

Some college

Tools

CPR+

Waystar

Job description

PharMerica, an affiliate of BrightSpring Health Services, seeks a Payer Audit Specialist to manage payer audit requests, compile documentation, and respond within deadlines. The role supports Medicare, Medicaid, and commercial payers while ensuring compliance and quality assurance across billing records.

Responsibilities include coordinating across departments, analyzing audit trends, and maintaining accuracy in medical documentation and responses.