Remote Medicaid Pre-Billing Auditor - Risk & Compliance

Colonial Group; Fresno, Northern (CA, KY); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health insurance

403(b) Retirement Savings Plan with 3.

Paid Time Off (PTO)

Tuition Reimbursements

CPR certification training

Career Development training

Any Day Pay with Dayforce Wallet

Job summary

AbleLight is seeking a Medicaid Pre-Billing Auditor to independently review Medicaid claims, coding and documentation. Remote role for candidates in CA, CO, MN, WA, OR or MO, with focus on pre-billing audits and reducing regulatory risk.

Strong emphasis on auditing accuracy and cross-functional collaboration. Requirements include a Bachelor’s in healthcare administration or accounting and 5+ years in auditing, with CPC/CCS-P/CPMA/CHC or equivalent credentials.

Qualifications

• Bachelor’s degree in healthcare administration, accounting or related field.
• Five+ years of auditing or related experience.
• Credentials such as CPC, CCS-P, CPMA, CHC or equivalent.

Responsibilities

• Audit Medicaid claims and records on a risk-based, prospective and retrospective basis.
• Impose internal billing holds when pre-billing audits find non-compliant documentation.
• Evaluate coding and billing accuracy across CPT, HCPCS, ICD-10-CM.
• Prepare concise audit reports and oversee corrective actions and follow-up.

Skills

Auditing

Regulatory compliance

Data analytics

AI-assisted auditing

Education

Bachelor’s degree in healthcare administration or accounting

Equivalent combination of education and experience

Tools

Audit-management platforms

Compliance-monitoring software

Analytics tools

Job description

AbleLight is seeking a Medicaid Pre-Billing Auditor to independently review Medicaid claims, coding and documentation. Remote role for candidates in CA, CO, MN, WA, OR or MO, with focus on pre-billing audits and reducing regulatory risk.

Strong emphasis on auditing accuracy and cross-functional collaboration. Requirements include a Bachelor’s in healthcare administration or accounting and 5+ years in auditing, with CPC/CCS-P/CPMA/CHC or equivalent credentials.