Remote Healthcare Audit & Compliance Specialist

Quipt Home Medical, Corp.; Grand Blanc (MI); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Quipt Home Medical, Corp. is seeking an Audit Specialist to conduct audits of billing, documentation, insurance claims, and regulatory compliance within the DME sector.

You will collaborate with billing, intake, clinical, and management teams to ensure payer guidelines are met and reimbursements are accurate. The role emphasizes identifying compliance risks, preparing reports, and supporting corrective action plans, with a focus on Medicare, Medicaid, and commercial payer requirements, while

Qualifications

• Experience in healthcare auditing, medical billing, or DME compliance.
• Knowledge of CMS/Medicare/Medicaid and payer regulations.
• Ability to review medical documentation and insurance claims.
• Strong analytical and problem-solving skills with attention to detail.

Responsibilities

• Perform routine and targeted audits of patient files, billing records, and supporting clinical documentation.
• Review documentation to ensure compliance with Medicare, Medicaid, commercial insurance, and accreditation standards.
• Verify that orders, medical necessity, POD, prior authorizations, and records meet payer requirements.
• Identify potential compliance risks and billing vulnerabilities.
• Audit submitted claims for coding accuracy and payer guidelines; identify denials and recoupments.
• Collaborate with billing staff to resolve discrepancies and implement corrective actions.
• Prepare audit reports outlining findings, trends, risk levels, and recommendations.
• Track audit metrics and monitor corrective action plans; present findings to management.
• Provide education to staff on audit findings and compliance requirements.

Skills

DMEPOS billing

Medicare rules

HCPCS coding

Audit methods

Revenue cycle

Excel

Documentation review

Communication

Education

High school diploma or GED

Tools

Brightree

Job description

Quipt Home Medical, Corp. is seeking an Audit Specialist to conduct audits of billing, documentation, insurance claims, and regulatory compliance within the DME sector.

You will collaborate with billing, intake, clinical, and management teams to ensure payer guidelines are met and reimbursements are accurate. The role emphasizes identifying compliance risks, preparing reports, and supporting corrective action plans, with a focus on Medicare, Medicaid, and commercial payer requirements, while