Role Description The Pre-Bill Audit Specialist plays a critical role in supporting timely and accurate reimbursement by performing pre-bill audits and ensuring billing requirements are met before home health claims are submitted. This position partners closely with billing teams and agency operations to identify and resolve documentation and claim issues efficiently while maintaining compliance and supporting quality patient care. This role is ideal for detail-oriented healthcare professionals who enjoy problem-solving, collaboration, and working in a fast-paced remote environment. - Perform pre-bill audits to verify all billing requirements are satisfied prior to claim submission. - Review medical documentation to ensure accuracy, completeness, and compliance with billing standards. - Coordinate with agency leadership, billing teams, and interdisciplinary teams to resolve issues delaying claim submission. - Communicate effectively with internal teams and contract agencies regarding audit findings and billing requirements. - Confirm visit documentation is complete and available for all services to be billed. - Troubleshoot claim holds and assist agencies in resolving outstanding issues in a timely manner. - Maintain current knowledge of home health billing requirements and regulatory expectations. - Escalate issues to leadership promptly and provide recommendations for resolution. - Demonstrate professionalism, accountability, and commitment to continuous improvement. Qualifications - High school diploma or GED required. - Active state license as one of the following (preferred): - Licensed Vocational Nurse (LVN) / Licensed Practical Nurse (LPN) - Multi-state license issued through the Nurse Licensure Compact (NLC) - Certified Occupational Therapy Assistant (COTA) - Physical Therapist Assistant (PTA) - Current driver’s license required. - Minimum two (2) years of healthcare experience required. - Home health and/or hospice experience strongly preferred. - Knowledge of auditing practices, medical documentation, and billing requirements. - Strong attention to detail and organizational skills. - Proficiency with computers, Excel, and/or Google Sheets. - Ability to manage multiple priorities and meet deadlines. - Strong communication and collaboration skills. - Ability to work independently and within a team environment. Work Environment - Remote work environment during standard business operating hours. - Occasional extended hours as business needs require. - Limited local travel may be required with potential exposure to varying weather conditions. Physical Requirements - Prolonged sitting with occasional standing. - Ability to work under deadlines and manage competing priorities. - Requires manual dexterity, hand-eye coordination, and analytical problem-solving skills. Join a team committed to operational excellence and supporting quality patient care through accurate and compliant billing practices.

• Supporting companies through the certification process • Managing an assigned customer portfolio • Building new customer relationships and identifying market potential • Conducting on-site audits in the field • Verifying compliance with international standards in the cosmetics and laundry & cleaning products industries

• Schedule and conduct premium audits with insured clients. • Collect and review required documentation in compliance with client requirements. • Prepare accurate audit reports according to company standards. • Communicate effectively with insureds and internal stakeholders. • Manage workload independently while meeting deadlines and quality standards.

Role Description The Clinical Auditor I performs detailed medical record audit review and analysis of the health plan’s outpatient, professional and ancillary claims to ensure that all reimbursement to the provider is paid accurately and ensuring adherence to regulations, internal policies and best practice of patient care. Qualifications - Bachelor's degree in nursing or an equivalent combination of education, training, and experience is required. - Two years CM, UM, claims auditing or other clinical health insurance role. - Two years minimum RN experience in acute care setting. - Behavioral Health and/or Inpatient DRG experience required. Requirements - Valid Registered Nurse License required. - Coding Certification Preferred - CPC or CCS certification. - Basic familiarity with CPT, ICD-10 and HCPCS coding is preferred. - Claims processing experience is preferred. Benefits - Full-time remote work. - Competitive salaries. - Excellent benefits. - Generous total compensation that includes benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Key Functions/Responsibilities - Analyze patient records, treatment plans, and medical billing documents to ensure accuracy, completeness, and strict compliance with healthcare standards and regulations. - Verify that procedures and diagnoses are accurately coded using appropriate CPT, HCPCS, and ICD-10 codes. - Check for consistent documentation across patient records, confirming that all entries adhere to regulatory mandates, internal policies, contract stipulations, and benefit coverages. - Identify any documentation or billing discrepancies during the review process. - Based on audit findings, regularly update and refine clinical audit guidelines and protocols. - Use statistical and analytical methods to examine clinical data. - Methodically review data to identify discrepancies and irregularities. - Analyze data trends to determine potential areas of risk. - Continuously monitor and document recurring patterns or anomalies in clinical data. - Provide well-founded recommendations for new audit projects. - Conduct both scheduled and ad hoc audits in strict accordance with established guidelines and internal processes. - Develop comprehensive audit reports that clearly outline all findings. - Play a supportive role in the amendment and appeals process. - Finalize all audits by ensuring that all findings are documented. - Collaborate closely with clinical staff, audit coordinator, and other members of the audit team. - Maintain active communication with providers by preparing precise documentation. - Ensure that any audit denial rationale is clearly communicated. - Continuously monitor evolving federal and state healthcare regulations. - Evaluate clinical and reimbursement activities to determine payment compliance. - Proactively identify potential fraud and abuse. - Refer cases to the Special Investigations Unit (SIU) or the Third-Party Liability team. - Detect potential quality of care or utilization issues during audits. - Assist in educating clinical personnel on documentation requirements and audit practices.