Durable Medical Equipment Supplies Claims Auditor

Responsibilities

• 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 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
• 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
• Avoid 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

What is expected of you and others at this level

• 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

Pay

Anticipated hourly range: $33/hr - $37.68/hr

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