Audit Specialist

IRB Medical Equipment LLC•Grand Blanc, MI

8m•Hybrid

About The Position

The Audit Specialist is responsible for conducting audits of billing, documentation, insurance claims, and regulatory compliance activities. This role ensures adherence to Medicare, Medicaid, commercial insurance, and accreditation requirements while identifying opportunities to improve reimbursement accuracy, reduce audit risk, and support operational excellence. The Audit Specialist works closely with billing, customer service, intake, clinical, and management teams to monitor compliance with payer guidelines, validate documentation requirements, and support corrective action plans.

Requirements

Professional, proactive, and positive demeanor with internal and external customers and coworkers.
High school diploma or general education degree.
Minimum of 6 months of experience in healthcare auditing, medical billing, compliance, or DME operations.
Experience with Medicare, Medicaid, and commercial insurance regulations.
Experience reviewing medical documentation and insurance claims.
Strong understanding of DMEPOS billing requirements.
Strong understanding of Medicare documentation standards.
Strong understanding of HCPCS coding and modifiers.
Strong understanding of audit methodologies.
Strong understanding of revenue cycle processes.
Excellent analytical and problem-solving skills.
Strong attention to detail and organizational abilities.
Advanced proficiency in Microsoft Excel and reporting tools.
Ability to communicate findings professionally and objectively.
Proficient English, verbal and written.
Ability to add, subtract, multiply, and divide in all units of measure using a calculator.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.

Nice To Haves

Experience with Brightree or other DME software preferred.

Responsibilities

Perform routine and targeted audits of patient files, billing records, and supporting clinical documentation.
Review documentation to ensure compliance with Medicare, Medicaid, commercial insurance, and accreditation standards.
Verify that physician orders, medical necessity documentation, proof of delivery, and dispensing records meet payer requirements.
Identify potential compliance risks and billing vulnerabilities.
Audit submitted claims for coding accuracy and compliance with payer-specific guidelines.
Review HCPCS coding, modifiers, and supporting documentation.
Identify claim submission errors, denials, overpayments, and underpayments.
Collaborate with billing staff to resolve discrepancies and implement corrective actions.
Validate completeness and accuracy of Standard Written Orders (SWO), Medical Necessity Documentation, Proof of Delivery (POD), Prior Authorizations, Clinical Notes, Certificates and supporting payer-required documentation.
Ensure records are maintained according to federal and state regulations.
Maintain knowledge of CMS, Medicare, Medicaid, commercial payer regulations, and DME industry standards.
Monitor regulatory updates affecting reimbursement and documentation requirements.
Assist with preparation for external audits conducted by Medicare contractors, commercial payers, accreditation agencies, or government entities.
Prepare audit reports outlining findings, trends, risk levels, and recommendations.
Track audit metrics and monitor corrective action plans.
Present findings to management and department leaders.
Assist leadership in developing policies and procedures to strengthen compliance.
Provide feedback and education to staff regarding audit findings.
Participate in training initiatives related to documentation, billing accuracy, and compliance requirements.
Support continuous quality improvement programs.