Diabetes Supplies Claims Auditor

Cardinal Health

9d•$33 - $38•Remote

About The Position

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 diabetic supplies claims, including Continuous Glucose Monitors (CGMs), blood glucose monitoring products, insulin pumps, insulin pump supplies, testing supplies, and related diabetes care products. 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. What Ethics & Compliance contributes to Cardinal Health 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.

Requirements

Bachelor’s degree in related field, or equivalent work experience, preferred
3-5 years of related work experience supporting auditing and monitoring programs for diabetic supplies providers/suppliers, including experience with CGM, diabetes testing supplies, insulin pumps, and related medical necessity requirements, 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

Nice To Haves

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.

Responsibilities

Perform compliance monitoring and auditing activities for a DMEPOS supplier, including post-payment claim reviews for diabetic care products and supplies, such as Continuous Glucose Monitors (CGMs), blood glucose monitors, testing supplies, insulin pumps, insulin pump supplies, lancets, and related diabetic equipment.
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.