? We're Hiring: Healthcare Audit Specialist! ?

We are looking for a detail-oriented Audit Specialist to join our team in ensuring compliance and optimizing healthcare processes. The ideal candidate will possess robust analytical skills and experience in auditing practices within the healthcare sector.

? Location: Bangalore, India

⏰ Work Mode: Hybrid

? Role: Audit Specialist The Audit Specialist supports the Audit department by auditing, submitting, monitoring, and resolving VA and Medicaid claims for Home Health, Home Health Aide, and Respite Care services. This role requires strong knowledge of insurance coverage, state-specific billing regulations, authorization requirements, and timely filing guidelines, particularly for Managed Care Organizations, including extension and reprocessing timelines.

Key responsibilities include correcting claim errors, managing clearinghouse and payer rejections, resolving denials, tracking appeals and escalations, and ensuring timely and accurate reimbursement. This individual serves as a subject-matter expert for assigned payers and state billing requirements and partners with internal teams to resolve complex billing issues.

This position also requires the ability to interpret EOBs, remittances, and EOPs to determine appropriate next steps, even without direct access to payer portals. The ideal candidate is a proactive problem-solver who can develop and communicate solutions, write clear provider summaries, and share knowledge by teaching and supporting the team. Strong attention to detail, disciplined follow-through, flexibility, and the ability to manage multiple priorities while meeting daily productivity standards are essential.





The specialist serves as a key point of contact for provider escalations and ensures accurate tracking and documentation in HubSpot. This position reports to the Audit Manager.

Core Responsibilities

Audit assigned claims daily to confirm accuracy of:

Member/patient info, DOS, units/visits, service type

Diagnosis codes, provider identifiers, authorizations, attachments Validate documentation supports billed services (orders, POC, visit notes)

Submit clean claims via clearinghouse or payer-specific processes

Apply VA Community Care, VCA, and authorization model rules correctly

Understand state-specific Medicaid and MCO billing requirements

Ensure compliance with EVV, COB, eligibility, and medical necessity rules

Interpret EOBs, RAs, and EOPs to determine next actions

Resolve clearinghouse and payer rejections within 72 hours

Identify root causes and correct claims end-to-end

Prepare and track reconsiderations, appeals, and escalations

Monitor timely filing, corrected claim, and resubmission windows

Perform biweekly follow-ups on unadjudicated and adjudicated claims

Run and interpret daily/weekly reports for:

Rejections, denials, underpayments, pending claims, timely filing risks Maintain clear, complete audit documentation in HubSpot Experience and Skills:

Minimum of 1-3 years of experience in home health billing, audits, denials, and appeals (VA and/or Medicaid strongly preferred)

Strong understanding of authorizations, eligibility, and payer rules

Experience with clearinghouses, payer portals, and claim corrections

Excellent organization, documentation, and follow-through

Proficient in MS Office, billing/EMR systems, and reporting tools

Proven ability to reduce denials and rejections through trend analysis

📌 Audit Specialist - Healthcare domain (Bengaluru)
🏢 Eastvantage
📍 Bengaluru