We only have these two roles opened in India from our USA client , so please confirm if your profile suits for Audit Specialist or Collections Specialist, please check both the JD and confirm. Also please forward your updated resume with other details here Also provide the following details.

Location: BTM Layout, Bangalore, India
⏰ Work Mode: Work from office, USA Shift, transportation will be provided

Role: Audit SpecialistThe 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 transparent 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) with excellent communication skills
- 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

Collections Specialist JD As a Collections Specialist, you will serve as a bridge between the billing department and third-party payers to resolve overdue claims and collect payments. In this role,



you will be responsible for ensuring accurate billing and efficient collections processes within our healthcare organization.Core Responsibilities Monitor accounts to identify overdue payments and correct errors in previously submitted claims to ensure full payment Clearly communicate with team members, third-party payers, and customers regarding identified claims errors via phone and email Identify, analyze, and research trends in claims rejections and partial payments to create resolutions Prioritize activities to work denials and partial payments in a timely manner to avoid timely filing limitations Leverage reporting tools for comprehensive data analysis, creating targeted action plans to resolve billing issues Utilize coding systems (CPT, ICD-10) to guarantee meticulous billing and collections Process and reprocess medical claims in accordance with payer regulations, protocols, medical authorizations, and departmental guidelinesExperience and Skills Minimum 2 years of experience in medical billing and collections Experience working with third-party payers, such as VA, Medicaid, Medicare Advantage, and Worker’s Compensation Experience with revenue cycle management Experience working with UB04 and HCFA 1500 forms Familiarity with Electronic Medical Record (EMR) systems Knowledge of health care collections procedure codes and techniques Proficiency in using billing software (Clearinghouse) and electronic health records (EHR) Proficiency in reading and interpreting ERAs and EOB for all payers In-depth knowledge of healthcare billing codes (CPT, ICD-10) Proven success in reducing accounts receivable and improving collections In-depth knowledge of HIPAA compliance Excellent follow-up, time management, and communication skills required Familiarity with PowerBI preferred Proficiency in MS Office Suite (Outlook, Word, Excel) required Education and Qualifications Associate degree required in Healthcare Administration, Business, or a related field (bachelor's degree preferred) Equivalent combination of education and experience will be considered

Pay: ₹25,000.00 - ₹58,104.71 per month

Benefits:

- Health insurance
- Provident Fund

Work Location: In person

📌 Medical Billing Specialist for USA Based client of East Vantage (BTM 1st Stage)
🏢 Eastvantage - For US healthcare client
📍 BTM 1st Stage