{"id":1618162,"url":"https://alion.io/job/ablelight-medicaid-pre-billing-auditor","title":"Medicaid Pre-Billing Auditor","company":{"id":1952409,"name":"AbleLight","domain":"ablelight.org","url":"https://alion.io/company/ablelight","size_band":"1001-5000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Dayforce","truth_index":null},"role":"Finance","role_family":"Finance","seniority":"senior","employment_type":null,"work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Fresno, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":88000,"max_usd":167000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":4723},"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-09-30T06:00:00Z","employer_posted_date":"2026-10-01","last_verified_at":"2026-10-21T06:06:09Z","board_verified":true,"closed_at":null,"days_open":21,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":21},"description":"Put Your Heart to Work! \nAt AbleLight, we believe the world shines brighter when people with developmental disabilities achieve their full potential. We pioneer life-changing services that empower the people we serve to thrive.\n\nThe Medicaid Pre-Billing Auditor independently evaluates Medicaid billing, coding, authorizations, service documentation, and related reimbursement practices to determine whether claims are accurate, properly coded, and compliant with federal and state requirements. A primary focus will be pre-billing audits. The role identifies billing risks, imposes billing holds before defective billing is initiated, recommends corrective actions, and monitors remediation to reduce regulatory risk. Limited reviews involving commercial payers may also be performed based on organizational need. \n\nRequirements\nBachelor’s degree in healthcare administration, accounting or a related field; or an equivalent combination of relevant education and experience.\nMinimum of five years of experience in auditing or a related function, including direct experience reviewing claims, coding, and supporting documentation for accuracy and regulatory compliance.\nOne of the following:\nCertified Professional Coder (CPC) through AAPC; or \nCertified Coding Specialist–Physician-based (CCS-P) through AHIMA; or \nCertified Professional Medical Auditor (CPMA); or \nCertified in Healthcare Compliance (CHC); or \nAnother relevant healthcare coding, audit, compliance, or health information credential \n\nBenefits: \nWe support the whole person and have designed our benefits with you and your family's total well-being in mind:\nHealth and Wellness: Medical, Dental, and Vision benefits starting the first of the month following 30 days of employment and access to Teledoc \nFinancial Wellness: 403(b) Retirement Savings Plan with 3.5% matching contributions, Health Savings Account, Flexible Savings Account, and Basic Life, AD&D, STD, and LTD insurance \nWork/Life Balance: Paid Time Off (PTO), Tuition Reimbursements \nTraining program will allow you to become CPR certified \nOngoing training to support Career Development\nWe are now also offering Any Day Pay. With Dayforce Wallet, you get access to your pay as soon as you've earned it at no additional cost to you.\n\nResponsibilities: \nAuditing and Monitoring (70%) \nConduct risk-based, prospective, and retrospective audits of Medicaid claims and records. \nDetermine whether documentation meets payer requirements. Impose internal billing holds where pre-billing audits find documentation does not meet billing standards. \nEvaluate coding and billing accuracy using applicable CPT, HCPCS, ICD-10-CM, Medicaid program, waiver, managed-care, and state-specific requirements. \nSupport billing-related risk assessments, investigations, payer audits, government inquiries, and compliance reviews as assigned. \nPromptly escalate suspected overpayments and other significant concerns in accordance with organization procedures. \nReporting and Corrective Action (10%) \nMaintain complete and defensible audit reports documenting audit objectives, criteria, methodology, samples, evidence reviewed, exceptions, conclusions, and reviewer decisions. \nAnalyze findings to identify patterns, control weaknesses, potential financial exposure, and opportunities for process improvement. \nPrepare concise written reports, dashboards, and presentations that communicate findings and recommended actions to Compliance leadership and appropriate stakeholders. \nRecommend practical corrective actions and collaborate with accountable leaders to establish responsibilities, target dates, and validation measures. \nMonitor corrective-action progress, perform follow-up testing, and determine whether remediation is effective and sustainable. \nMaintain records of findings, corrective actions, management responses, and closure evidence. \nCross-Functional Collaboration and Audit Technology (10%) \nWork collaboratively with various departments while preserving the objectivity of the Compliance audit function. \nHelp evaluate and implement audit-management platforms, compliance-monitoring software, analytics tools, dashboards, and automated exception-reporting capabilities. \nUse approved data analytics and AI-assisted auditing technologies to analyze claims and documentation, identify outliers, prioritize higher-risk records, recognize recurring patterns, and expand audit coverage. \nConsultation and Regulatory Support (10%) \nServe as a subject-matter resource on Medicaid billing, coding, documentation, reimbursement, and audit requirements. \nMonitor relevant Medicaid billing manuals, waiver requirements, regulatory updates, payer guidance, coding changes, and enforcement activity. \nIdentify education needs arising from audit results and provide content expertise to various departments. \nAssist with the development or revision of organization policies and procedures","description_format":"text","description_chars":4907,"description_truncated":false,"requirements":{"experience_years_min":5,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":["Retirement plans"],"hiring_locations":[],"hiring_excludes":[],"relocation_offered":false,"industries":["Health Insurance & Benefits","Health Care","Business Development","Disability Support 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