Revenue Integrity & Compliance Auditor

Paylocity; Grand Blanc, Northern (MI, KY); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Paylocity is seeking an Audit Specialist to conduct audits of billing, documentation, insurance claims, and regulatory compliance to safeguard reimbursement accuracy and support operational excellence.

You will collaborate with billing, intake, clinical, and management teams to monitor payer guidelines, validate documentation, and drive corrective action plans while maintaining high standards of compliance across Medicare, Medicaid, and commercial payers.

Qualifications

• High school diploma or GED required.
• Minimum of 6 months of experience in healthcare auditing, medical billing, compliance, or DME operations.
• Experience with Medicare, Medicaid, and commercial insurance regulations.
• Experience reviewing medical documentation and insurance claims.

Responsibilities

• Perform routine and targeted audits of patient files, billing records, and supporting clinical documentation.
• Review documentation to ensure compliance with Medicare, Medicaid, commercial insurance, and accreditation standards.
• Verify that physician orders, medical necessity documentation, proof of delivery, and dispensing records meet payer requirements.
• Identify potential compliance risks and billing vulnerabilities.
• Audit submitted claims for coding accuracy and compliance with payer‑specific guidelines.
• Collaborate with billing staff to resolve discrepancies and implement corrective actions.

Skills

DMEPOS billing requirements

Medicare/Medicaid knowledge

HCPCS coding and modifiers

Audit methodologies

Revenue cycle processes

Microsoft Excel

Brightree

Education

High school diploma or GED

Tools

Brightree

EMR systems

Job description

Paylocity is seeking an Audit Specialist to conduct audits of billing, documentation, insurance claims, and regulatory compliance to safeguard reimbursement accuracy and support operational excellence.

You will collaborate with billing, intake, clinical, and management teams to monitor payer guidelines, validate documentation, and drive corrective action plans while maintaining high standards of compliance across Medicare, Medicaid, and commercial payers.