Diabetes Supplies Claims Auditor

Summary

The Durable Medical Equipment Supplies Claims Auditor plays a key role in supporting Cardinal Health ’s Ethics and Compliance program by helping ensure claims-related processes are accurate, compliant, and aligned with applicable payer and regulatory requirements. This role performs auditing and monitoring activities for diabetic supplies claims, including Continuous Glucose Monitors (CGMs), blood glucose monitoring products, insulin pumps, insulin pump supplies, testing supplies, and related diabetes care products. Identifies trends and potential compliance risks, and partners with cross-functional teams. The ideal candidate is analytical, detail-oriented, collaborative, and comfortable working in a fast-paced healthcare environment where sound judgment, clear communication, and a commitment to continuous improvement are essential.

What Ethics & Compliance contributes to Cardinal Health

Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.

Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.
Responsibilities

- Perform compliance monitoring and auditing activities for a DMEPOS supplier, including post-payment claim reviews for diabetic care products and supplies, such as Continuous Glucose Monitors (CGMs), blood glucose monitors, testing supplies, insulin pumps, insulin pump supplies, lancets, and related diabetic equipment.

- Perform root cause analysisthrough review of claims, documentation, payer requirements, workflows, and operational processes toidentifytrends, compliance risks, and remediation opportunities.

- Track results and trendsand reportfindingstomanagerto supportresultdashboards

- Clearly document and communicate risks, issues, rootcauses, customerimpacts, andprovide remediationrecommendations.

- As applicable, attend in-service, continuingeducationor seminar programs to stay current with industry trends.

- Collaborate effectively across the organization toassistand advise onprocess improvements; gather support from colleagues and/or other key partners.

- Assistin implementingmonitoring procedures for claims related processes while collaborating cross-functionally with stakeholders to improve operational alignment and process improvement initiatives.

- Implement processes toensurethecollection ofaccurateauditing and monitoringdatathat will support a data driven compliance programand helpidentifyareas ofrisk

- Adapt effectively to evolving priorities, regulatoryrequirements, and business processes within a fast-paced environment.

Qualifications

- Bachelor’s degree in related field, or equivalent work experience, preferred

- 3-5 years of related work experience supporting auditing and monitoring programs for diabetic supplies providers/suppliers, including experience with CGM, diabetes testing supplies, insulin pumps, and related medical necessity requirements, preferred.

- Strong knowledge and understanding of healthcare industry regulations and guidelines preferred (Federal Anti-Kickback, False Claims, Stark Law, Beneficiary Inducement Statute)

- Strong knowledge of Medicare Local Coverage Policies, Medicaid manuals, and other insurance billing requirements.

- Strong organizational skills with the ability to support multiple projects in afast-pacedenvironment

- Ability tocreate andcommunicate data-basedfindings andinformation effectively to non-technical audiences

- Related work experience with Brightree, preferred

- Strong co