Durable Medical Equipment Supplies Claims Auditor

AuditorAuditorFull TimeRemoteMid LevelTeam 10,001+Since 1971H1B SponsorCompany SiteLinkedIn

Location

EST (UTC-5)

Posted

4 days ago

Salary

$33 - $38 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Durable Medical Equipment Supplies Claims Auditor

Cardinal Health

Role Description The Durable Medical Equipment Supplies Claims Auditor plays a key role in supporting Cardinal Health’s Ethics and Compliance program by helping ensure claims-related processes are accurate, compliant, and aligned with applicable payer and regulatory requirements. This role performs auditing and monitoring activities for DMEPOS supply claims, identifies trends and potential compliance risks, and partners with cross-functional teams. The ideal candidate is analytical, detail-oriented, collaborative, and comfortable working in a fast-paced healthcare environment where sound judgment, clear communication, and a commitment to continuous improvement are essential. Responsibilities - Perform compliance monitoring and auditing activities for a DMEPOS supplier, including but not limited to post-payment claim reviews for medical supplies such as Ostomy, Urological, Diabetic, Wound Care, Enteral, and Incontinence supplies, as well as monitoring for pharmacy Part D claims. - Perform root cause analysis through review of claims, documentation, payer requirements, workflows, and operational processes to identify trends, compliance risks, and remediation opportunities. - Track results and trends and report findings to manager to support result dashboards. - Clearly document and communicate risks, issues, root causes, customer impacts, and provide remediation recommendations. - Attend in-service, continuing education, or seminar programs to stay current with industry trends. - Collaborate effectively across the organization to assist and advise on process improvements; gather support from colleagues and/or other key partners. - Assist in implementing monitoring procedures for claims-related processes while collaborating cross-functionally with stakeholders to improve operational alignment and process improvement initiatives. - Implement processes to ensure the collection of accurate auditing and monitoring data that will support a data-driven compliance program and help identify areas of risk. - Adapt effectively to evolving priorities, regulatory requirements, and business processes within a fast-paced environment. Qualifications - Bachelor’s degree in related field, or equivalent work experience, preferred. - 3-5 years of related work experience supporting auditing and monitoring programs for DMEPOS suppliers and medical necessity expertise preferred. - Strong knowledge and understanding of healthcare industry regulations and guidelines preferred (Federal Anti-Kickback, False Claims, Stark Law, Beneficiary Inducement Statute). - Strong knowledge of Medicare Local Coverage Policies, Medicaid manuals, and other insurance billing requirements. - Strong organizational skills with the ability to support multiple projects in a fast-paced environment. - Ability to create and communicate data-based findings and information effectively to non-technical audiences. - Related work experience with Brightree, preferred. - Strong communication and presentation skills. - Proficiency in MS Word, Excel, PowerPoint, and Outlook. - Will be working EST business hours. Requirements - Applies principles and technical capabilities to perform varied auditing and monitoring tasks. - Ability to learn different system technologies and support audits of these platforms. - Works on special projects of moderate scope and complexity. - Ability to interpret various payor rules and policies for auditing and monitoring. - Identify possible solutions to a variety of technical findings and take action to recommend remediation strategies. - Applies sound judgement within defined parameters. - Completes work independently with ability to implement action plans based on general guidance. - Receives general guidance and may receive more detailed instructions on new projects. - Work reviewed for sound reasoning and accuracy. - Ability to work collaboratively. - Customer-oriented attitude and seek to understand approach to helping others. - Strong analytical, organizational, written, and verbal communication skills. Benefits - Medical, dental and vision coverage. - Paid time off plan. - Health savings account (HSA). - 401k savings plan. - Access to wages before payday with myFlexPay. - Flexible spending accounts (FSAs). - Short- and long-term disability coverage. - Work-Life resources. - Paid parental leave. - Healthy lifestyle programs.

Related Categories

Related Job Pages

More Auditor Jobs

Role Description Gear Inc. seeking a Financial Auditor to play a crucial role in safeguarding our financial integrity and ensuring compliance with relevant regulations. The financial auditor will conduct comprehensive financial audits, analyze financial data, and identify areas for improvement. - Conduct comprehensive financial audits and assess internal controls to ensure the accuracy and reliability of financial information; - Analyze financial data to identify trends, anomalies, and potential risks, identifying areas for improvement; - Ensure compliance with regulations and accounting standards; - Prepare audit reports and communicate observations to stakeholders, summarizing the findings of the audit and providing recommendations for improvement; - Contribute to continuous improvement of financial processes; - Share your knowledge and expertise with colleagues and management to promote a culture of continuous learning and development. Qualifications - Bachelor's degree in Finance, accounting, or related field; - At least 3-5 internal audit work experience preferably with big 4 audit experience; - Relevant professional qualifications (e.g. CPA, CIA) would be preferred; - Proficiency in using auditing software and tools (e.g., ACL, IDEA); - Knowledge of relevant financial regulations and standards (e.g., GAAP, IFRS); - An analytical thinker with strong investigative and problem-solving skills; - Outstanding attention to detail with excellent organizational skills; - Ability to work under pressure and meet tight deadlines; - Excellent report-writing and communication skills; - Strong communication and interpersonal skills, with the ability to effectively collaborate and communicate with stakeholders at all levels. Company Description

Singapore
Sentara Healthcare logo

Compliance Coding Auditor

Sentara Healthcare

Founded in 1888 as a 25-bed Retreat for the Sick, Sentara Healthcare is now the largest integrated health care provider in Virginia and northeastern North Carol

Auditor5 days ago

Compliance Coding Auditor Location: Norfolk United States Job Description: City/State Norfolk, VA Work Shift First (Days) Overview: Compliance Coding Auditor Performs a number of functions including those of physician education, internal auditing, coder education, management of AR queries/problems, and liaison with external auditors for corporate audits. The internal audit program assures optimal ethical reimbursement for Sentara's patients, and also assures that the coding practices fall within established compliance guidelines. Both ICD and CPT coding methodologies are used in the internal audit activity. The Auditor must exhibit competence in Correct Coding Initiative (CCI), National Coverage Determination (NCD), Hierarchical Conditionals Categories (HCC) and other federal payer policies, and is expected to achieve mastery in the MPFS payment methodology, including the impact on Relative Value Unit (RVU) value related to Non-Physician Practitioner (NPP) services, Provider Based Billing (PBB) locations, and all other complex coding protocols within one year. All queries arising from the audit process are managed by the Compliance Auditor. Follows audit plan, completing numerous audits and providing follow-up to coders, management, and physicians. Looks for new problem areas, trends, etc., and advises Manager of Audit and Coding Compliance. Works with leadership regarding scheduling of internal and external audits. Education - Associate Level degree preferred but required Certification/Licensure - CPC or CCS certification (Required) Experience - 4+ years of experience with multi-specialty coding (Required) - 4+ years of experience with acute care outpatient coding (Required) - Professional fee coding experience (Required) Remote work opportunity preferred candidates in the Virginia/North Carolina geographic location Benefits: Caring For Your Family and Your Career - Medical, Dental, Vision plans - Adoption, Fertility and Surrogacy Reimbursement up to $10,000 - Paid Time Off and Sick Leave - Paid Parental & Family Caregiver Leave - Emergency Backup Care - Long-Term, Short-Term Disability, and Critical Illness plans - Life Insurance - 401k/403B with Employer Match - Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education - Student Debt Pay Down - $10,000 - Reimbursement for certifications and free access to complete CEUs and professional development - Pet Insurance - Legal Resources Plan - Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met. Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission "to improve health every day," this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Virginia + 28 moreAll locations: Virginia | North Carolina | Alabama | Delaware | Florida | Georgia | Idaho | Indiana | Kansas | Louisiana | Maine | Maryland | Minnesota | Nebraska | Nevada | New Hampshire | North Dakota | Ohio | Oklahoma | Pennsylvania | South Carolina | South Dakota | Tennessee | Texas | Utah | Washington | West Virginia | Wisconsin | Wyoming
Astreya logo

Telecom Auditor III

Astreya

IT services that put people at the center of your business

Auditor5 days ago
Full TimeRemoteTeam 1,001-5,000Since 2001H1B Sponsor

• Audit vendor invoices against signed contracts, order forms and internal monitoring tools to identify billing discrepancies • Lead review of vendor network performance reports for any vendor service interruptions that breach contractual availability • Working directly with vendors to dispute any billing discrepancies and issues • Report group spending on a month-to-month basis to identify spending trends and to help identify areas for further cost reductions and focus • Report financial analysis findings to the Client • Construct audit reports using online spreadsheets • Summarize audit reports using online spreadsheets • Propose new audit projects for cost savings opportunities • Identify process efficiencies • Other duties as required.

Texas
$69.1K - $115.2K / year
CLEAResult logo

Commercial Energy Auditor

CLEAResult

We change the way people use energy.™

Auditor5 days ago
Full TimeRemoteTeam 1,001-5,000Since 2003H1B Sponsor

• Travel daily throughout a defined territory • Conduct entry-level commercial energy audits for small and mid-sized facilities • Engage directly with customers and contractors to explain program offerings, encourage participation, and address basic questions • Accurately document inspections, installations, and customer interactions in accordance with program requirements • Perform on-site installation of energy efficiency measures, including physical labor and use of basic tools • Identify, troubleshoot, and escalate basic technical or installation issues to program staff as needed

Oklahoma
$18 - $23 / hour