Audit Specialist

RiseMe; Grand Blanc (MI); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Hart Medical Equipment in Grand Blanc, MI is seeking an Audit Specialist to audit billing, documentation, insurance claims, medical records, and regulatory compliance to improve reimbursement accuracy and reduce audit risk.

You will collaborate with billing, customer service, intake, clinical, and management teams to verify payer requirements, prepare findings, and support corrective action plans, while maintaining file completeness and regulatory standards.

Qualifications

• High school diploma or GED required.
• Minimum 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.

Responsibilities

• Audit routine and targeted(patient files, billing records, and supporting documentation) to ensure compliance with payer requirements.
• Review HCPCS coding, modifiers, and supporting documentation for accuracy.
• Identify denials, overpayments, and underpayments; collaborate with billing to resolve discrepancies.
• Monitor regulatory updates and assist with external audits and corrective action plans.
• Prepare audit reports with findings, trends, and recommendations; support training initiatives.

Skills

Analytical thinking

Attention to detail

Communication

Organizational skills

Microsoft Excel

Education

High school diploma or GED

Tools

Brightree

DME software

Job description

Hart Medical Equipment provides a full range of home care products and support services based on individual needs. We strive to conduct our patient care operation with the highest standards. We are a nationally accredited, premier provider of home medical equipment and supplies.

Status: Full Time

Location: Grand Blanc, MI

Hart Medical Equipment offers a competitive salary and benefits package. EOE

SUMMARY:

The Audit Specialist is responsible for conducting audits of billing, documentation, insurance claims, medical records, 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.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Compliance Auditing

• 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.

Billing and Claims Auditing

• 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.

Documentation Review

• 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.

Regulatory Compliance

• 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.

Reporting and Analysis

• 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.

Education and Training

• 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.

SUPERVISORY RESPONSIBILITES

This position has no supervisory responsibilities.

QUALIFICATIONS

To perform this job successfully, an individual must be professional, proactive and positive with internal and external customers and coworkers. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Education and/or Experience

• 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.

Knowledge and Skills

• Strong understanding of:
  • DMEPOS billing requirements
  • Medicare documentation standards
  • HCPCS coding and modifiers
  • Audit methodologies
  • 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.
• Experience with Brightree or other DME software preferred.

Working Conditions

• Primarily office-based with opportunities for remote work depending on department policy.
• Frequent use of computer systems, billing platforms, and electronic medical records.
• Ability to review large volumes of documentation and maintain productivity while meeting deadlines.

Performance Indicators

• Audit completion accuracy and timeliness.
• Reduction in billing and documentation errors.
• Successful implementation of corrective action plans.
• Compliance with regulatory and accreditation standards.
• Improvement in claim acceptance and reimbursement rates.
• Decrease in payer recoupments and audit findings.

Language Skills

• Proficient English, verbal and written.

Mathematical Skills

• Ability to add, subtract, multiply, and divide in all units of measure using a calculator.

Analytical & Problem Solving Ability

• 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.

This position plays a critical role in protecting company revenue, ensuring regulatory compliance, and maintaining the highest standards of documentation and billing accuracy within the durable medical equipment industry.

CERTIFICATES, LICENSES, REGISTRATIONS

• None

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, talk and hear. Specific vision abilities required by this job include close vision. All employees are required to work in a safe manner.

WORK ENVIRONMENT

The work environment described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Office environment with moderate noise level.

TRAINING

Orientation and selected courses, including individualized training, must be completed in the designated time frame.

IRB Medical Equipment LLC, dba Hart Medical Equipment, is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, national origin, citizenship age, disability genetic information, height, weight, marital or veteran status or any other protected status in accordance with the requirements of applicable federal state and local laws. Hart Medical Equipment also provides reasonable accommodation for individuals with disabilities in accordance with applicable law.