Conduct front-end audits of claims prior to submission to identify errors, inconsistencies, or missing information
Review documentation, scheduling data, authorizations, and payer requirements to research and resolve discrepancies
Communicate with providers and internal teams to verify services delivered and ensure accurate claim representation
Make corrections and updates within the practice management system to produce clean, submission-ready claims
Apply payer-specific and state-specific billing rules to ensure compliance and minimize denials
Interpret and apply billing regulations to resolve new or complex scenarios effectively
Review Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), and bank deposits to accurately post payments
Reconcile posted payments against deposit totals and investigate discrepancies or underpayments
Identify and escalate payer trends, issues, or inconsistencies
Generate and update patient invoices as needed
Follow up with patients or responsible parties on outstanding balances
Document all communication attempts and payment arrangements
Support timely resolution of accounts receivable to improve overall financial performance

Experience with medical billing, claims auditing, or revenue cycle management
Strong understanding of payer requirements, billing compliance, and claims processes
Ability to interpret and apply billing rules across multiple payers and states
Experience reviewing EOBs/ERAs and posting payments accurately
Proven ability to reconcile payments and identify discrepancies
Strong attention to detail and problem-solving skills
Excellent communication skills for collaborating with providers and internal teams
Ability to work independently and manage high-volume workflows

Claims Auditor, Billing Specialist

Key skills