Revenue Cycle Documentation & Audit Specialist - Medical Devices presso Quest Health Solutions LLC

Description

Overview of the Role

The Revenue Cycle Management (RCM) Documentation & Audit Specialist is responsible for acquiring and verifying documentation for medical device resupply patients, with a focus on insurance changes, payer guideline updates, and post-denial corrections. This role requires strong knowledge of Medicare billing requirements, clinical criteria, and medical record review to ensure accuracy and compliance. In addition to document retrieval from patients and physicians’ offices, the specialist conducts both internal and external audits, compiling and submitting comprehensive packages to meet Medicare and payer standards. By blending documentation management with audit responsibilities, this position plays a vital role in reducing denials, maintaining compliance, and supporting overall revenue cycle efficiency.

Essential Duties and Responsibilities

Document Retrieval & Verification

• Obtain required documents for resupply patients, such as when insurance changes require updated guidelines or when post-denial corrections are necessary.
• Communicate directly with patients and physicians’ offices to request, track, and secure needed documentation.
• Review all received records for accuracy, completeness, and compliance with Medicare local coverage determinations (LCDs) and payer requirements before routing back to the appropriate team.

Audit Responsibilities

• Conduct both internal audits (to ensure adherence to company policy and documentation standards) and external audits (Medicare and other payer requests).
• Compile, organize, and submit audit packages with supporting clinical documentation, demonstrating understanding of medical records, clinical criteria, and Medicare audit expectations.

Collaboration & Workflow Management

• Serve as a liaison between departments by addressing documentation gaps, clarifying requirements, and moving accounts back into workflow once issues are resolved.
• Partner with the Revenue Cycle, Resupply, and Billing teams to ensure timely resolution of escalations and compliance with payer requirements.

System Utilization

• Use e-prescribe platforms, EMRs, and customer relationship management (CRM) systems to track documentation requests, audit responses, and task completion.

Benefits 

• Medical, Dental, and Vision Insurance 
• Life Insurance coverage 
• Paid time off and Holiday Pay 
• 401K with company match option 
• Growth opportunities 

Requirements

What You’ll Bring

• DME & Medicare Knowledge: Previous experience in Durable Medical Equipment (DME) billing and revenue cycle management, with a strong understanding of Medicare billing rules, LCDs, and payer documentation requirements.
• Medical Record Review: Demonstrated ability to interpret, evaluate, and validate clinical documentation for accuracy, completeness, and compliance with Medicare and insurance criteria.
• Audit Experience: Hands-on experience preparing and submitting audit packages for Medicare or other payers, with knowledge of audit standards and best practices.
• Communication Skills: Strong verbal and written communication skills to work directly with patients, physicians’ offices, and internal departments to secure necessary information and resolve documentation gaps.
• Organizational Skills: Ability to manage multiple requests and audits simultaneously, prioritize tasks effectively, and meet strict deadlines.
• Technical Proficiency: Familiarity with Brightree, e-prescribe platforms, and CRM or EMR systems to track documentation and audit tasks.