Billing Audit Specialist
About The Position
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 overpayments, and compliance risks while helping improve overall claims accuracy and operational performance.
Requirements
- 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
- 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
Nice To Haves
- associate or bachelor's degree in healthcare, business, health information management, or a related field preferred.
Responsibilities
- 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 overpayments, and improve compliance.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
