Billing Audit Specialist

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Norwood, MA, US

11 days ago Requisition

Salary Range: $35.00 To $40.00 Hourly

Equal Opportunity Employer/Disability/Veterans

Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.

Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.

The DME Audit Specialist is responsible for conducting detailed payer audits of durable medical equipment (DME) claims, supporting documentation, and billing to ensure compliance with specific insurance requirements, Medicare/Medicaid regulations, company policies, and applicable industry standards. This position identifies billing discrepancies, documentation deficiencies, potential over payments, and compliance risks while helping improve overall claims accuracy and operational performance.

• Conduct comprehensive audits of DME claims, patient records, orders, medical documentation, and billing records.
• Review claims for accuracy, completeness, medical necessity, coding compliance, and adherence to payer guidelines.
• Validate documentation requirements for DME products, including physician orders, delivery documentation, proof of delivery, clinical records, and other supporting materials.
• Review HCPCS codes, modifiers, diagnosis codes, units, quantities, and other claim elements for accuracy.
• Research applicable CMS, Medicare Administrative Contractor (MAC), payer, and regulatory guidelines.
• Prepare detailed audit findings, supporting documentation, and recommendations for corrective action.
• Track audit results, trends, and recurring deficiencies and communicate findings to appropriate departments.
• Maintain accurate audit records and ensure all work is completed within established timelines.
• Identify opportunities to strengthen processes, reduce claim denials, prevent over payments, and improve compliance.

• 18 years of age or older
• Must be eligible to work in the United States and not require work authorization from us now or in the future
• High school diploma or equivalent required; associate or bachelor's degree in healthcare, business, health information management, or a related field preferred.
• 2+ years of experience in DME, medical billing, healthcare auditing, coding, reimbursement, compliance, or a related field.
• Working knowledge of DME billing and reimbursement practices.
• Familiarity with CMS Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and DME Medicare Administrative Contractor requirements.
• Ability to manage multiple audits and meet deadlines while maintaining a high level of accuracy.
• Knowledge of HCPCS Level II coding, modifiers, medical necessity requirements, and DME documentation standards.
• Ability to interpret medical records, billing documentation, payer policies, and regulatory requirements.

• Effective and professional verbal and written communication abilities
• Professional computer experience (especially Microsoft Office Suite)
• Ability to work independently to investigate and make decisions
• Proven analytical and problem-solving skills with exceptional attention to detail
• Strong written and verbal communication skills
• Advances Proficiency in excel
• Analytical Skills
• Initiative
• Job Knowledge
• Multitasking
• Productivity
• Problem Solving
• Organizational skills

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
• This role routinely uses standard office equipment such as computers, phones, and printers/scanners

The work environment…