Remote Claims Audit Supervisor - QA & Compliance Lead

Cardinal Health; Salem (OR); Hybrid; USD 69,000 - 88,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

401k plan

HSA

FSAs

Disability coverage

Parental leave

Wellness programs

Job summary

Cardinal Health is seeking a Revenue Cycle Management audit lead in the United States to oversee audit activities, ensure accuracy of clinical documentation, and drive compliance with federal and state regulations. You will lead cross-functional teams, respond to audit requests, and develop corrective actions while maintaining timely communication with payors and CMS.

The role offers full-time employment with standard business hours and remote components as needed, plus a comprehensive benefits

Qualifications

• 4-8 years of experience, preferred.
• Bachelor's degree in related field, or equivalent work experience, preferred.
• Leadership, project management, or supervisory experience preferred.
• Urology or wound care product knowledge preferred.

Responsibilities

• Oversee the Audit team and respond to audit requests in a timely manner and develop audit processes.
• Focus on quality assurance, quality improvement, and collaborative activities to support compliance initiatives.
• Lead dedicated team responsible for reviewing validity of clinical documentation for accuracy and compile response packets for audits.
• Work with team members to complete tasks in a timely manner and to high standards.
• Provide monthly feedback on audit or recoupment inquiries and related areas.
• Oversee all aspects of a TPE, CERT, RAC, pre/post payment, or 3rd party audit and respond in time.
• Oversee all aspects of a Recoupment or Refund request and respond in time.
• Monitor, track, and trend audits in progress and completed.
• Gather and review documentation from insurance companies for accuracy and submission approval.
• Ensure regular communication with CMS and/or other auditors about issues.
• Ensure audits meet legal requirements and company policies.
• Review and release claims marked for QA Review on hold.
• Assist with development of policies and enforce compliance.
• Perform extensive reviews of accounts to determine correct payments and review contracts/fee schedules.

Skills

Leadership

Project management

Supervisory experience

Regulatory knowledge

Audit knowledge

Urology knowledge

Education

Bachelor's degree in related field

Job description

Cardinal Health is seeking a Revenue Cycle Management audit lead in the United States to oversee audit activities, ensure accuracy of clinical documentation, and drive compliance with federal and state regulations. You will lead cross-functional teams, respond to audit requests, and develop corrective actions while maintaining timely communication with payors and CMS.

The role offers full-time employment with standard business hours and remote components as needed, plus a comprehensive benefits