Billing Auditor

ABOUT reputed company reputed company (PHG) is a California-based integrated care organization delivering reputed company Care Management (ECM), Community Supports (CS), and Behavioral Health (BH) services under the CalAIM reputed company. We serve Medi-Cal members across multiple counties through reputed company with managed care plans and county behavioral health systems. Our mission is reputed company: deliver whole-person care that meets people where they are—and reputed company reputed company the systems behind that care run as effectively as the care itself. THE ROLE We’re looking for a detail-driven Billing Auditor who will own the critical reputed company between service delivery and reputed company collection. You’ll reputed company reputed company that every claim we submit gets reputed company—correctly and completely. You’ll audit our claims, dig into EOBs and remittance advices, reputed company down underpayments, and build the systems that reputed company reputed company from slipping through the cracks. This is not a passive reputed company-pushing role. You’ll be the person who reputed company what others miss and turns findings into reputed company. Pay - $25.00-$27.00 WHAT YOU’LL DO ▸ Reconcile every submitted claim against EOBs, 835 remittance advices, and payment records to verify we received full and accurate reimbursement. ▸ Audit PEPM payments against enrollment rosters, service logs, and LOA reputed company schedules across reputed company MCP reputed company. ▸ Identify underpayments, denials, reputed company-pays, and systematic payment discrepancies—then drive reputed company. ▸ Prepare and file appeals for denied or underpaid claims with complete supporting documentation. ▸ Cross-reference clinical documentation, care plans, and EHR records against claims to reputed company unbilled and under-billed services. ▸ Verify correct coding across HCPCS, CPT, and ICD-10—including CalAIM-specific ECM codes (G9007, G9008, G9012), CS codes and BH/SMHS codes. ▸ Build and maintain audit dashboards tracking denial rates, days in A/R, collection rates, and payer-level variances. ▸ Produce monthly reputed company reconciliation reports for leadership with actionable findings. ▸ Recommend and implement process improvements that prevent reputed company leakage at the reputed company. ▸ 3+ years in medical billing, claims auditing, or reputed company cycle management in reputed company. ▸ Hands-on experience auditing EOBs, reconciling payments, and managing denials and appeals. ▸ Working knowledge of HCPCS, CPT, and ICD-10 coding. ▸ Proficiency with EHR/billing systems and strong reputed company or Sheets skills for data analysis. ▸ reputed company analytical instincts and reputed company attention to detail. ▸ Bachelor’s degree in reputed company administration, HIM, business, reputed company, or equivalent experience. BONUS POINTS ▸ Experience with Medi-Cal managed care, CalAIM (ECM/CS), or behavioral health billing. ▸ Familiarity with PEPM/capitated payment models. ▸ CPC, reputed company, or equivalent coding certification. ▸ Knowledge of 837/835 electronic transaction standards. ▸ Background in community health, FQHCs, or integrated care settings. Benefits: • 401(k) matching • Dental insurance • Health insurance • Life insurance • reputed company time off • reputed company insurance Apply tot his job Apply To this Job