Billing and Compliance Audit Specialist

The Billing and Compliance Audit Specialist is responsible for conducting comprehensive internal billing and compliance audits, managing interactions with payors and third parties for external audits, and developing robust training and Standard Operating Procedures (SOPs) for the reimbursement team. This role plays a critical part in ensuring compliance with regulatory requirements and optimizing reimbursement processes.

Responsibilities:

• Internal Audits:
  • Perform regular and thorough internal billing and compliance audits to ensure adherence to company policies and regulatory standards.
  • Analyze and interpret audit findings, identify areas of risk, and recommend corrective actions.
• External Audit Coordination:
  • Collaborate with payors and third parties to manage the full external audit lifecycle, including tracking, response, and communication.
  • Work closely with internal and external legal counsel to ensure all audit-related activities comply with legal and regulatory requirements.
• Training and Development:
  • Conduct comprehensive training for the reimbursement team to enhance understanding of billing and compliance standards.
  • Develop innovative training materials, including written SOPs, video training, and other creative methods to effectively engage and educate team members.
  • Implement ongoing retraining initiatives to ensure continuous improvement and adherence to best practices. 
• SOP Development:
  • Create and maintain up-to-date SOPs for the reimbursement function, ensuring clarity and accessibility for all team members.Regularly review and update SOPs to reflect changes in regulations or company policies.
• Reporting and Communication:
  • Report audit findings and compliance metrics directly to the VP of Reimbursement.
  • Present detailed audit reports and insights to key leaders within the organization, highlighting significant trends and recommendations for improvement.

Qualifications:

• Preferred: Bachelor’s degree in Finance, Business Administration, Healthcare Management, or a related field.
• Preferred: Certified Professional Coder, Certified Professional Biller and/or Certification in Healthcare Compliance.
• Proven experience in billing and compliance audits, preferably within the healthcare industry.
• Strong understanding of reimbursement processes and regulatory requirements.
• Excellent communication and interpersonal skills for effective collaboration with internal teams and external partners.
• Ability to develop training materials and conduct engaging training sessions.
• Proficient in data analysis and presenting complex information clearly and concisely
• Detail-oriented with strong analytical skills.
• Ability to work independently and as part of a team.
• Strong organizational and time management skills.
• Proficient in using audit and compliance software tools.
• Comfortable working with cross-functional teams and managing multiple priorities.

Benefits And Perks:

• Working with a team of ‘rockstars’ who bring out the best in everyone
• Open, transparent culture that includes weekly Town Hall meetings
• The ability to indirectly or directly change the lives of hundreds of thousand patients
• Multiple medical benefit options; employee premiums paid 100% of select plans, dependents covered at 80%
• Extremely generous Family Bonding Leave for new parents (16 weeks, paid at 100%)
• Retirement savings program including a 4% Company match
• Free daily on-site lunches provided from top eateries
• Latest and greatest hardware (laptop, lab equipment, facilities)
• A variety of perks on campus (state of the art gym, restaurant)
• Free on-site EV charging (compatible with all EVs, including Tesla)

At BillionToOne, we are proud to offer a combination of a (1) base pay range (actual amount offered is based on experience and salary/equity options split that the candidate chooses), (2) generous equity options offering, (3) corporate bonus program, on top of (4) industry leading company benefits (free healthcare options, 401k match, very generous fully paid parental leave, etc.).

For this position, we offer a total compensation package of $135,450 per year, including a base pay range of $81,600 - $102,000 per year.

BillionToOne is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.