Diabetes Supplies Claims Auditor

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. I dentifies 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.

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 analysis   through review of claims, documentation, payer requirements, workflows, and operational processes to   identify   trends, compliance risks, and remediation opportunities.    Track results and trends   and report   findings   to   manager   to support   result   dashboards    Clearly document and communicate risks, issues, root   causes, customer   impacts, and   provide remediation   recommendations.   As applicable, attend in-service, continuing   education   or seminar programs to stay current with industry trends.   Collaborate effectively across the organization to   assist   and advise on   process improvements; gather support from colleagues and/or other key partners .    Assist   in imple men ting   monitoring procedures for claims related processes while collaborating cross-functionally with stakeholders to improve operational alignment and process improvement initiatives.     Implement processes to   ensure   the   c ollect ion of   accurate   auditing and monitoring   data   that will support a data driven compliance program   and help   identify   areas of   risk   Adapt effectively to evolving priorities, regulatory   requirements , and business processes within a fast-paced en vironment.

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, Med icaid manuals, and other insurance billing requirements.    Strong organizational skills with the ability to support multiple projects in a   fast-paced   environment   Ability to   create and