Billing Audit & Overpayment Specialist

Billing Audit SpecialistReliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes CGM devices, insulin pumps, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, and breast pumps. Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible. The Billing Audit Specialist is responsible for reviewing and responding to audit requests received from payers. This is a remote opportunity for someone who resides in New England. Duties and ResponsibilitiesReview and respond to audit requests from payer appeal denial claims Inform necessary department of audit requirements Participate in training necessary departments on process changes to meet payer expectations Research and analyze paid health insurance claims to identify overpayments Review benefit plans, payer contracts, fee schedules, and payment policies Determine root causes of overpayments (e.g., duplicate payments, coordination of benefits issues, pricing errors, eligibility errors) Document findings clearly and maintain detailed audit trails Initiate and track overpayment recovery activities, including offsets or refund requests Respond to payer inquiries and disputes related to overpayment findings Ensure compliance with state, federal, and contractual regulations Identify trends and recommend process improvements to reduce future overpayments Meet productivity, accuracy, and turnaround time standards Perform other duties and special projects as assigned and directed Basic Qualifications18 years of age or older Must be eligible to work in the United States and not require work authorization from us now or in the future High School diploma or equivalent required; college preferred At least 3 years of experience in medical billing or relevant experience Required SkillsEffective and professional verbal and written communication abilities Great customer service skills Professional computer experience (especially Microsoft Office Suite) Ability to work independently to investigate and make decisions Strong attention to detail Ability to prioritize and complete work amidst interruptions in a busy work area Available during normal hours of operation Ability to comply with guidelines both internal and industry-imposed CompetenciesComputer Skills Customer Service Ethics Organization Skills Productivity Results Driven Work Environment & Physical DemandsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time. This role routinely uses standard office equipment such as computers, phones, and printers/scanners. This job is operated in a professional office environment. The noise level in the work environment is usually moderate to loud.