Reliable Respiratory · 19 hours ago
Billing Audit & Overpayment Specialist
Boston, MA, US
Full-time
Onsite
Mid Level
$30/hr - $35/hr
3+ years expReliable 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. The Billing Audit Specialist is responsible for reviewing and responding to audit requests received from payers and ensuring compliance with state, federal, and contractual regulations.
Medical DeviceHealthcareMedical
No H1B
Responsibilities
Review and respond to audit requests from payer appeal denial claims
Inform necessary department of audit requirements
Participating 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
Qualification
Required
18 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
Effective 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
Company
Reliable Respiratory
Reliable Respiratory operates as a home respiratory and specialty medical equipment providers.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase