Claims Audit Lead - Compliance & Quality

Cardinal Health; Helena (MT); On-site; USD 69,000 - 88,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off plan

401k savings plan

Health savings account (HSA)

Access to wages before pay day with my

Flexible spending accounts (FSAs)

Disability coverage (short/long-term)

Work-Life resources

Paid parental leave

Healthy lifestyle programs

Job summary

Cardinal Health, based in Dublin, Ohio, seeks an experienced Revenue Cycle Management Auditor to oversee audit activities and ensure compliance with federal and state regulations. You will lead a team reviewing clinical documentation, respond to audit requests, and drive process improvements across the revenue cycle.

The role involves collaborating with CMS and payors, ensuring timely action on audits and recoupments.

Qualifications

• 4-8 years of experience preferred.
• Bachelor's degree in related field, or equivalent work experience preferred.
• Leadership, project management, or supervisory experience preferred.
• Urology or wound care product knowledge preferred.

Responsibilities

• Oversee the Audit team and respond to all audit requests in a timely manner; develop and implement audit processes.
• Focus on quality assurance, quality improvement, and compliance with Federal and State regulations.
• Lead dedicated team responsible for reviewing validity of clinical documentation for accuracy and compile response packets for audits.
• Coordinate with team members to ensure timely completion of tasks and maintain high standards.
• Provide monthly feedback on successes/failures related to audits, recoupment inquiries, payor collections, and policies.
• Oversee all aspects of a TPE, CERT, RAC, pre/post payment, or 3rd party audit and respond in required time frame.
• Oversee all aspects of a Recoupment or Refund request and respond in required time frame.
• Monitor, track, and trend all current, in progress, and completed audits.
• Gather and review all documentation for audits, recoupments, or other documentation requests from insurance companies for accuracy and submission approval.
• Ensure communication with CMS and other auditors about issues or concerns.
• Ensure audits meet legal requirements and company policies.
• Review and release of claims marked for QA Review on hold.
• Assist with development of company policies and enforcing compliance.
• Perform extensive reviews of accounts to determine if correct payments were made to providers.
• Review provider contracts/fee schedules to determine correct payment methodology.
• Prepare reports summarizing findings and recommending corrective action.
• Stay up to date on Medicare updates and educational trainings.

Skills

Leadership

Project management

Supervisory experience

Urology knowledge

Wound care knowledge

Education

Bachelor's degree in related field or equivalent

Job description

Cardinal Health, based in Dublin, Ohio, seeks an experienced Revenue Cycle Management Auditor to oversee audit activities and ensure compliance with federal and state regulations. You will lead a team reviewing clinical documentation, respond to audit requests, and drive process improvements across the revenue cycle.

The role involves collaborating with CMS and payors, ensuring timely action on audits and recoupments.