Medical Claims Processor

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 DMEPOS supply claims, 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 but not limited to post‑payment claim reviews for medical, specifically Ostomy, Urological, Diabetic, Wound Care, Enteral and Incontinence supplies, as well monitoring for pharmacy Part D claims 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 implementing 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 collection 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 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 DMEPOS suppliers and medical necessity expertise 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 a fast‑paced environment Ability to create and communicate data‑based findings and information effectively to non‑technical audiences Related work experience with Brightree, preferred Strong communication and presentation skills Proficiency in MS Word, Excel, PowerPoint, and Outlook Will be working EST business hours What is expected of you and others at this level Applies principles, and technical capabilities to perform varied auditing and monitoring tasks Ability to learn different system technologies and support audits of these platforms Works on special projects of moderate scope and complexity Ability to interpret various payer rules and policies for auditing and monitoring Identify possible solutions to a variety of technical findings and take action to recommend remediation strategies Applies sound judgment within defined parameters Completes work independently with ability to implement action plans based on general guidance Receives general guidance and may receive more detailed instructions on new projects Work reviewed for sound reasoning and accuracy Ability to work collaboratively Customer oriented attitude and seek to understand approach to helping others Strong analytical, organizational, written and verbal communication skills. Anticipated hourly range: $33/hr - $37.68/hr Bonus eligible: No Benefits: Medical, dental and vision coverage Paid time off plan Health savings account (HSA) 401k savings plan Access to wages before pay day with myFlexPay Flexible spending accounts (FSAs) Short- and long‑term disability coverage Work‑Life resources Paid parental leave Healthy lifestyle programs Application window anticipated to close: 08/28/2026 *if interested in opportunity, please submit application as soon as possible. The salary range listed is an estimate. Pay at Cardinal Health 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. Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law. To read and review this privacy notice click here ( #J-18808-Ljbffr