Conduct end-to-end audits of provider charge masters (CDM) and associated claims to evaluate billing accuracy, rate structures, and adherence to contractual and regulatory requirements.
Review and analyze provider chargemaster data to identify outliers, inconsistencies, or policy violations.
Assist in the development and maintenance of audit models, dashboards, and templates to support enterprise audit functions.
Prepare audit summaries with findings and recommendations.
Support provider communications regarding audit findings and recommend process improvements.
Maintain current knowledge of CMS guidelines, payer policies, and healthcare billing standards (UB-04, CPT, HCPCS, revenue codes).
Contribute to reimbursement and contract review projects.

2-4 years in provider auditing, revenue integrity, hospital billing, or charge master analysis
Proficiency in Microsoft Office Suite products (Access, Excel, Word, PowerPoint, etc.), SAS, SQL, PowerBI, or other software used for both analytic, reporting, and data visualization functions.
Knowledge of CPT/HCPCS coding, CMS billing guidelines, and provider reimbursement methodologies.
Bachelor’s degree in healthcare administration, Health Information Management, Accounting, or related field.
Preferred certifications: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA).

Provider Audit Specialist

Key skills