Durable Medical Equipment (DME) Auditor

EXL•United States,

11d•$50,000 - $65,000•Remote

About The Position

The DME Auditor reviews professional claims and medical records to verify that services were provided as billed, assess coding and payment accuracy, and identify overpayments, undercharges, overcharges, and unbundled items. The role applies knowledge of DME, Medicare, Medicaid, commercial reimbursement rules, payer unbundling guidelines, contract language, and fee schedules. Findings must be documented with clear references and rationale to support client reviews and overpayment recovery. The position includes managing audit inventory and scheduling audits with providers, maintaining timely communication with the Audit Coordinator, and reporting process problems to the Manager. Onsite travel of up to 10% may be required. The role requires compliance with HIPAA and company compliance, information security, and regulatory policies. The posting describes the position as suitable for someone comfortable working independently in a remote environment.

Requirements

Three or more years of experience in claims processing, medical billing, or auditing, with a strong focus on Durable Medical Equipment (DME).
In-depth knowledge of HCPCS codes and reimbursement policies.
Ability to read and interpret contract language and fee schedules.
Intermediate Excel and Word skills.
Basic math skills.
Comfort working independently in a remote environment.
Strong written and verbal communication, time management, and analytical skills.

Nice To Haves

RHIA, CPC, or similar certification; multiple credentials are a plus.
Experience with FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat, or Pricers.

Responsibilities

Review medical records to verify services were provided as billed for Hospital Bill Audit reviews.
Identify overcharges, undercharges, and unbundled items.
Identify unbundled items on itemized bills according to payer Unbundling Guidelines, and provide references and rationale to support review findings.
Maintain timely communication with the Audit Coordinator about scheduling, completion, and submission of audits involving onsite travel.
Follow EXL’s Travel policy when arranging travel for onsite audits.
Manage audit inventory and schedule audits promptly by contacting providers to arrange dates and times.
Report problems in the audit process to the Manager for resolution.
Comply with HIPAA and other regulations concerning the confidentiality of patient information.
Perform job functions in accordance with company Compliance, Information Security, and Regulatory policies, procedures, and programs.