DME Claims Auditor & Compliance Analyst

Reliable Respiratory; Worcester (MA); On-site; USD 60,000 - 75,000; Full time

Job summary

Reliable Respiratory is a Worcester, MA-based DME provider delivering respiratory, diabetes, urology, and maternity support equipment. The DME Audit Specialist will perform detailed payer audits of claims, supporting documentation, and billing to ensure compliance with insurance requirements and CMS/NCD guidelines.

The role focuses on identifying discrepancies, corrective recommendations, and improving overall claims accuracy.

Qualifications

• 18 years of age or older.
• Must be eligible to work in the United States without current/future sponsorship.
• High school diploma or equivalent; associate or bachelor’s degree preferred in healthcare, business, HIM, or related field.

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 including orders, delivery documentation, proof of delivery, and clinical records.
• Review HCPCS codes, modifiers, diagnosis codes, units, and claim elements for accuracy.
• Research CMS, MAC, payer and regulatory guidelines.
• Prepare audit findings, supporting documentation, and corrective-action recommendations.
• Track audit results, trends, and deficiencies; communicate findings to departments.
• Maintain audit records and meet established timelines.
• Identify opportunities to strengthen processes, reduce denials, and prevent overpayments.

Skills

Communication

MS Office

Independent work

Analytical thinking

Attention to detail

Multitasking

Problem solving

Organizational skills

Time management

Education

High school diploma or equivalent

Associates or Bachelors preferred

Tools

Microsoft Office Suite

Excel

Job description

Reliable Respiratory is a Worcester, MA-based DME provider delivering respiratory, diabetes, urology, and maternity support equipment. The DME Audit Specialist will perform detailed payer audits of claims, supporting documentation, and billing to ensure compliance with insurance requirements and CMS/NCD guidelines.

The role focuses on identifying discrepancies, corrective recommendations, and improving overall claims accuracy.