Billing Audit Specialist

RiseMe; Norwood (MA); On-site; USD 60,000 - 90,000; Full time

Job summary

Reliable Respiratory, INC is seeking a DME Audit Specialist to conduct comprehensive payer audits of DME claims and supporting documentation. You will ensure compliance with Medicare/Medicaid regulations and company policies while identifying deficiencies and opportunities for process improvements.

The role requires meticulous review of claims, documentation, and coding to prevent denials and overpayments, with a focus on accuracy and regulatory adherence in a fast paced DME environment.

Qualifications

• High school diploma or equivalent; degrees preferred in healthcare, business, health information management or related field.
• 2+ years of experience in DME, medical billing, healthcare auditing, coding, reimbursement, compliance or related field.
• Knowledge of CMS Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and DME MAC requirements.

Responsibilities

• Audit DME claims, patient records, orders, medical documentation, and billing records.
• Review claims for accuracy, medical necessity, coding, and payer guidelines.
• Validate documentation for DME products (orders, delivery, proof of delivery, clinical records).
• Review HCPCS codes, modifiers, diagnosis codes, units, quantities, and other claim elements for accuracy.
• Research CMS, MAC, payer guidelines.
• Prepare audit findings, supporting documentation, and recommendations for corrective action.
• Track audit results, trends, and recurring deficiencies; communicate findings to appropriate departments.
• Maintain accurate audit records and ensure deadlines are met.
• Identify opportunities to strengthen processes, reduce denials, prevent overpayments, and improve compliance.

Skills

MS Office Suite

Communication

Analytical skills

Attention to detail

Problem solving

Multitasking

Time management

Organization

Excel proficiency

Education

High school diploma or equivalent

Associate or bachelor’s degree in healthcare, business, health information management, or related field

Tools

MS Office Suite

Job description

Equal Opportunity Employer/Disability/Veterans

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.

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.

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.

Basic Qualifications

• 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; associate or bachelor's degree in healthcare, business, health information management, or a related field preferred.
• 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.

Required Skills

• 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

Competencies

• Advances Proficiency in excel
• Analytical Skills
• Attention to detail
• Initiative
• Job Knowledge
• Multitasking
• Productivity
• Problem Solving
• Communication skills
• Organizational skills

Work Environment & 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 communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
• This role routinely uses standard office equipment such as computers, phones, and printers/scanners

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This job is performed in a professional office environment
• The noise level in the work environment is usually moderate to loud

Direct Reports –None

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.