Claims Audit Supervisor: Remote Compliance Leader

cardinalhealth; United States; Remote; USD 69,000 - 88,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

401k savings plan

Access to wages before pay day

Job summary

Cardinal Health is seeking an Audit and Compliance specialist within Revenue Cycle Management. This role leads the Audit team, ensures quality assurance, supports compliance with Federal and State regulations, and coordinates responses to audits including TPE, CERT, RAC, and recoupment requests.

You will monitor audits, gather documentation, communicate with CMS and other auditors, and help develop company policies.

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 audit requests received by the company in a timely manner.
• Develop and implement audit processes.
• Lead dedicated team responsible for reviewing validity of clinical documentation for accuracy and compile response packets for successful audits.
• Work with team members to ensure all tasks are completed in a timely manner and to the highest standards possible.
• Provide monthly feedback on successes and failures and cover areas related to audits, payor collections inconsistencies, and policy procedures.
• Oversee all aspects of a TPE, CERT, RAC, pre/post payment, or 3rd party audit & respond in required time frame.
• Oversee all aspects of a Recoupment or Refund request and respond in required time frame.
• Monitor, track, and trend audits in progress and completed.
• Gather and review documentation for audits, recoupments, or other requests from insurers for accuracy and submission approval.
• Ensure communication with CMS and other auditors regarding issues.
• Ensure audits meet legal requirements and company policies.
• Review and release claims marked for QA Review on hold.
• Assist with development of policies and procedures and enforcing compliance.
• Perform reviews of accounts to determine correct payments and review contracts/fee schedules for correct payments.
• Prepare reports and recommend corrective actions.
• Stay updated on industry standards and Medicare updates and trainings.

Skills

Leadership

Project management

Supervisory experience

Education

Bachelor's degree or equivalent

Job description

Cardinal Health is seeking an Audit and Compliance specialist within Revenue Cycle Management. This role leads the Audit team, ensures quality assurance, supports compliance with Federal and State regulations, and coordinates responses to audits including TPE, CERT, RAC, and recoupment requests.

You will monitor audits, gather documentation, communicate with CMS and other auditors, and help develop company policies.