DME Billing Compliance Auditor

Reliable-Respiratory; Belmont Hill (MA); On-site; USD 48,000 - 55,000; Full time

Job summary

Reliable Respiratory is seeking a Billing Audit Specialist in Norwood, MA to conduct detailed payer audits of DME claims, supporting documentation, and billing to ensure compliance with insurance requirements and Medicare/Medicaid regulations.

The role requires auditing claims for accuracy, medical necessity, and coding compliance while identifying documentation gaps and opportunities to improve results and reduce denials.

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 while maintaining a high level of accuracy.
• Knowledge of HCPCS Level II coding, modifiers, medical necessity requirements, and DME documentation standards.

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.

Skills

Verbal communication

Written communication

MS Office Suite

Independent investigation

Analytical thinking

Attention to detail

Excel proficiency

Multitasking

Organizational skills

Problem solving

Education

High school diploma or equivalent

Associate or Bachelor's degree in healthcare, business, health information management, or related field preferred

Tools

Microsoft Office Suite

Job description

Reliable Respiratory is seeking a Billing Audit Specialist in Norwood, MA to conduct detailed payer audits of DME claims, supporting documentation, and billing to ensure compliance with insurance requirements and Medicare/Medicaid regulations.

The role requires auditing claims for accuracy, medical necessity, and coding compliance while identifying documentation gaps and opportunities to improve results and reduce denials.