Audit and Regulatory Specialist
Hybrid · Cleveland, Ohio, United States
Job Summary
Under the direction of the Director, Regulatory, Compliance and Risk, ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; and recommending opportunities to strengthen internal controls. Responsible for replying to and tracking external audit activity for a variety of payers including Medicare, Medicaid and commercial payers; handling appeals of denied audits; conducting internal audits to ensure compliance with policy changes driven by regulatory requirements; developing and providing employee training on compliance policies, practices, and reporting systems; identifying, investigating, and reporting compliance issues, irregularities, and violations; assisting with maintenance of branch records including licenses and other regulatory requirements; tracking and responding to patient grievances; and participating in other projects as required.
Required Qualifications
- Graduate of an accredited high school or GED equivalence
- DME Industry experience, preferably in a regulatory capacity
- Analytical skills (ability to break down problems, gather facts, and find logical solutions)
- Proficiency with Smartsheet, Microsoft Excel, Word and PowerPoint
- Familiarity with Medicare, State Medicaid and commercial insurance billing and reimbursements as related to DME
- Excellent verbal and written communication and customer relation skills
- Excellent interpersonal and organizational skills (team player)
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