DME Billing Audit & Compliance Specialist

Reliable Respiratory; Norwood (MA); On-site; USD 70,000 - 90,000; Full time

Job summary

Reliable Respiratory, INC in Norwood, MA, is seeking a DME Audit Specialist to conduct detailed payer audits of DME claims, verify documentation, and ensure coding and billing accuracy.

You will review HCPCS codes, provider orders, delivery proofs, and regulatory guidelines, and prepare findings with corrective action recommendations. The role requires 2+ years in DME or healthcare auditing, strong analytical skills, and proficiency with MS Office. E-Verify familiarity is a plus.

Qualifications

• 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 LCDs, NCDs, and DME MAC requirements.
• Ability to manage multiple audits and meet deadlines with high accuracy.
• Knowledge of HCPCS Level II coding, modifiers, and documentation standards.

Responsibilities

• Conduct comprehensive audits of DME claims, patient records, orders, medical documentation, and billing records.
• Review claims for accuracy, medical necessity, coding compliance, and payer guidelines.
• Validate documentation requirements for DME products and supporting materials.
• Review HCPCS codes, modifiers, diagnosis codes, units, and claim elements for accuracy.
• Research CMS, MAC, payer, and regulatory guidelines.
• Prepare audit findings, supporting documents, and corrective-action recommendations.
• Track audit results and communicate findings to appropriate departments.
• Maintain audit records and meet established timelines.
• Identify opportunities to reduce denials and prevent overpayments.

Job description

Reliable Respiratory, INC in Norwood, MA, is seeking a DME Audit Specialist to conduct detailed payer audits of DME claims, verify documentation, and ensure coding and billing accuracy.

You will review HCPCS codes, provider orders, delivery proofs, and regulatory guidelines, and prepare findings with corrective action recommendations. The role requires 2+ years in DME or healthcare auditing, strong analytical skills, and proficiency with MS Office. E-Verify familiarity is a plus.