Remote Medicaid Pre-Billing Auditor - Compliance & Risk

AbleLight; Fresno (CA); Remote; USD 90,000 - 100,000; Full time

Benefits offered by this job

Health and Wellness benefits

401(k) plan with match

Paid time off

Tuition reimbursement

Any Day Pay via Dayforce Wallet

Career development/training

Job summary

AbleLight is seeking a Medicaid Pre-Billing Auditor to independently evaluate Medicaid billing, coding, and related documentation to ensure accuracy, compliance, and proper pre-billing practices. A primary focus will be pre-billing audits with identifying billing risks and corrective actions.

This remote role welcomes candidates based in Colorado, California, Minnesota, Washington, Oregon or Missouri, with strong auditing and regulatory knowledge in healthcare.

Qualifications

• Bachelor’s degree in healthcare administration, accounting or a related field; or equivalent combination of education and experience.
• Minimum of five years of auditing experience including reviewing claims, coding, and supporting documentation for regulatory compliance.

Responsibilities

• Audit Medicaid claims and records (risk-based, prospective and retrospective).
• Determine documentation meets payer requirements and impose internal holds when needed.
• Evaluate coding and billing accuracy using CPT, HCPCS, ICD-10-CM and Medicaid rules.
• Support billing-related risk assessments, investigations and government inquiries.
• Escalate suspected overpayments per procedures.

Skills

Auditing

Regulatory compliance

Healthcare coding knowledge

Education

Bachelor’s degree in healthcare administration or accounting

Job description

AbleLight is seeking a Medicaid Pre-Billing Auditor to independently evaluate Medicaid billing, coding, and related documentation to ensure accuracy, compliance, and proper pre-billing practices. A primary focus will be pre-billing audits with identifying billing risks and corrective actions.

This remote role welcomes candidates based in Colorado, California, Minnesota, Washington, Oregon or Missouri, with strong auditing and regulatory knowledge in healthcare.