Diabetes Supplies Claims Auditor

reputed company The Durable Medical Equipment Supplies Claims Auditor plays a key role in supporting reputed company’s Ethics and Compliance program by helping ensure claims-reputed company processes are accurate, compliant, and reputed company with applicable payer and regulatory requirements. This role performs auditing and monitoring activities for diabetic supplies claims, including reputed company Glucose Monitors (CGMs), blood glucose monitoring products, insulin pumps, insulin pump supplies, testing supplies, and reputed company diabetes care products. Identifies trends and potential reputed company, and partners with cross-functional teams. The ideal candidate is analytical, reputed company-oriented, reputed company, and comfortable working in a fast-reputed company reputed company environment where reputed company judgment, reputed company communication, and a commitment to reputed company improvement are essential. What Ethics & Compliance contributes to reputed company 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 reputed company ethics and compliance issues. Ethics & Compliance develops and implements strategies and reputed company operating procedures to promote adherence to internal ethics and compliance policies reputed company to areas such as reputed company, 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 reputed company compliance monitoring and auditing activities for a DMEPOS supplier, including post-payment claim reviews for diabetic care products and supplies, such as reputed company Glucose Monitors (CGMs), blood glucose monitors, testing supplies, insulin pumps, insulin pump supplies, lancets, and reputed company diabetic equipment. reputed company reputed company cause analysis through review of claims, documentation, payer requirements, workflows, and operational processes to identify trends, reputed company, and remediation opportunities.   reputed company results and trends and report findings to manager to support result dashboards   reputed company document and communicate risks, issues, reputed company causes, customer impacts, and reputed company remediation recommendations.  As applicable, attend in-service, continuing education or seminar programs to stay reputed company with industry trends.  Collaborate effectively across the organization to assist and advise on process improvements; reputed company support from colleagues and/or other key partners.   Assist in implementing monitoring procedures for claims reputed company processes while collaborating cross-functionally with stakeholders to improve operational alignment and process improvement initiatives.   Implement processes to ensure the collection of accurate auditing and monitoring data that will support a data driven compliance program and help identify areas of reputed company  Adapt effectively to evolving priorities, regulatory requirements, and business processes reputed company a fast-reputed company environment.  Qualifications Bachelor’s degree in reputed company reputed company, or equivalent work experience, preferred 3-5 years of reputed company work experience supporting auditing and monitoring programs for diabetic supplies providers/suppliers, including experience with CGM, diabetes testing supplies, insulin pumps, and reputed company medical necessity requirements, preferred. Strong knowledge and understanding of reputed company industry regulations and guidelines preferred (Federal Anti-Kickback, False Claims, reputed company Law, Beneficiary Inducement Statute) Strong knowledge of Medicare Local Coverage Policies, reputed company manuals, and other reputed company billing requirements.   Strong organizational skills with the ability to support multiple reputed company in a fast-reputed company environment  Ability to create and communicate data-reputed company findings and information effectively to non-technical audiences  reputed company work experience with reputed company, preferred  Strong communication and presentation skills  Proficiency in reputed company, reputed company, PowerPoint, and reputed company  Will be working EST business hours What is expected of you and others at this level Applies principles, and technical capabilities to reputed company varied auditing and monitoring tasks  Ability to learn different reputed company and support audits of these platforms Works on special reputed company of moderate reputed company and complexity  Ability to interpret various payor rules and policies for auditing and monitoring   Identify possible solutions to a reputed company of technical findings and take reputed company to recommend remediation strategies  Applies reputed company judgement reputed company defined parameters  Completes work independently with ability to implement reputed company plans reputed company on general guidance   Receives general guidance and may receive more detailed instructions on new reputed company  Work reviewed for reputed company reasoning and reputed company  Ability to work collaboratively   Customer oriented attitude and reputed company to understand approach to helping others  Strong analytical, organizational, written and verbal communication skills.  Anticipated reputed company reputed company: $33/hr - $37.68/hr Bonus eligible: No Benefits: reputed company offers a wide reputed company of benefits and programs to support health and reputed company-being. Medical, dental and reputed company coverage reputed company time off plan Health savings account (HSA) 401k savings plan reputed company to wages before pay day with myFlexPay Flexible spending accounts (FSAs) Short- and long-term disability coverage Work-Life resources reputed company parental leave Healthy lifestyle programs Application window anticipated to reputed company: 10/05/2026 *if interested in opportunity, please submit application as soon as possible. The salary reputed company listed is an estimate. Pay at reputed company is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity. Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply. reputed company supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the reputed company of our differences to create reputed company solutions for our customers by ensuring employees can be their reputed company selves reputed company day. reputed company is an Equal Opportunity/Affirmative reputed company employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, religion, reputed company, national reputed company, reputed company, age, physical or mental disability, sex, sexual orientation, gender identity/reputed company, pregnancy, veteran status, marital status, creed, status with reputed company to reputed company assistance, genetic status or any other status protected by federal, state or local law. To read and review this reputed company notice click here Apply To This Job