Durable Medical Equipment Supplies Claims Auditor

Summary

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.

Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.

Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.

• Perform compliance monitoring and auditing activities for a DMEPOS supplier, including but not limited to post‑payment claim reviews for medical, specifically Ostomy, Urological, Diabetic, Wound Care, Enteral and Incontinence supplies, as well 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.
• As applicable, 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.

• 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

• 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 payer rules and policies for auditing and monitoring
• Identify possible solutions to a variety of…