[Hiring] 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.