DME Billing & Compliance Auditor

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

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.