DME Billing & Compliance Auditor

Reliable Respiratory; Norwood (MA); Hybrid; 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 and supporting documentation, ensuring compliance with Medicare/Medicaid requirements, company policies, and industry standards.

The role focuses on identifying billing discrepancies, potential overpayments, and compliance risks while helping improve claims accuracy and operational performance.

Qualifications

• 18 years of age or older.
• Eligible to work in the United States without future work authorization.
• 2+ years of experience in DME, medical billing, healthcare auditing, coding, reimbursement, or 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 accuracy.
• Knowledge of HCPCS Level II coding, modifiers, medical necessity, and DME documentation.

Responsibilities

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

Skills

Communication

Excel

Independence

Analytical thinking

Attention to detail

Multitasking

Problem solving

Organization

Education

High school diploma or equivalent

Healthcare/business-related degree preferred

Tools

DME billing systems

Job description

Reliable Respiratory is seeking a Billing Audit Specialist in Norwood, MA to conduct detailed payer audits of DME claims and supporting documentation, ensuring compliance with Medicare/Medicaid requirements, company policies, and industry standards.

The role focuses on identifying billing discrepancies, potential overpayments, and compliance risks while helping improve claims accuracy and operational performance.