[Hiring] Diabetes 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 diabetic supplies claims, including:

• Continuous Glucose Monitors (CGMs)
• Blood glucose monitoring products
• Insulin pumps
• Insulin pump supplies
• Testing supplies
• Related diabetes care products

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.

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 diabetic supplies providers/suppliers, including experience with CGM, diabetes testing supplies, insulin pumps, and related medical necessity requirements, 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 pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs