Manager, Auditing and Monitoring

What the Ethics and Compliance Department contributes to Cardinal Health

Ethics & Compliance fosters a culture of integrity, accountability, and ethical decision-making across the organization. Our team partners with business leaders and employees to proactively identify and address compliance risks, provide guidance on regulatory requirements, and ensure our practices reflect the highest standards of conduct. Through education, collaboration, and a risk-based approach, we help safeguard the organization’s reputation and support its mission to deliver trusted healthcare solutions.

Cardinal Health is seeking a driven, self-starter and highly skilled manager with expertise in healthcare regulatory compliance, including third party billing and reimbursement. This role will be responsible for providing sound compliance advice and guidance to Cardinal Health’s At-Home Solutions (“AHS”) business. At Home Solutions is a leading home healthcare medical supplies provider serving people with chronic and serious health conditions in the United States.

The AHS business unit is comprised of four complementary business units: (1) Edgepark Medical Supplies, (2) Advanced Diabetes Supply Group, (3) Cardinal Health at-Home, a direct-to-home medical supplies distributor, and (4) Velocare, a supply chain network and last-mile fulfillment solution.

Reporting to the Director of Ethics & Compliance – At-Home Solutions, this role is responsible for ensuring the company operates in line with compliance standards. Key duties involve managing billing audits for durable medical equipment, prosthetics, orthotics, and supplies(“DMEPOS”), including detection and correction of documentation, coding, identifying potential errors and/or medical necessity of items billed. And ensuring payor requirements are fulfilled.

The position also includes sharing audit findings with management, recommending training and solutions for issues found, supporting audit diligence and integration efforts, and overseeing an audit team dedicated to billing processes and audits.

Candidates should be adaptable, team-oriented, collaborative, and capable of working independently in a fast-paced setting with oversight from Ethics and Compliance leadership. This role will work closely with various cross‑functional colleagues across the AHS order entry and revenue cycle management team, Legal, the Enterprise Privacy Office, and other internal teams to identify and address potential issues and risks and help Cardinal Health comply with the evolving laws and regulations applicable to the AHS business.

• Provides compliance-related expertise and advice to Revenue Cycle management and other business teams with respect to day‑to‑day operations, including, without limitation, advice on Medicare and Medicaid DMEPOS supplier billing requirements, local coverage determination requirements, Medicare DMEPOS Supplier and Quality Standards, and other payor requirements.
• Serves as liaison with third party government contractors conducting audits as well as managing a small internal billing compliance team.
• Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to DMEPOS supplies billing and/or medical necessity reviews and other high‑risk areas as appropriate.
• Leads data analytics on audit outcomes; identifies and reviews audit trends and makes recommendations on remedial action to address such trends.
• Evaluates the appropriateness of items billed based on supporting record documentation and ensures documentation conforms to CMS and/or payor requirements.
• Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
• Collaborates with the Legal team to conduct risk assessments to define audit priorities based on previous audit findings, management priorities, national normative data, CMS initiatives, OIG work plans and advisories and healthcare industry best‑practices.
• Develops and implements compliance training to ensure compliance with…