Manager, Auditing and Monitoring

What the Ethics and Compliance Department contributes to Cardinal Health
 

Ethics & Compliance fosters a culture of integrity, accountability, and ethical decision-making across the organization. Our team partners with business leaders and employees to proactively identify and address compliance risks, provide guidance on regulatory requirements, and ensure our practices reflect the highest standards of conduct. Through education, collaboration, and a risk-based approach, we help safeguard the organization’s reputation and support its mission to deliver trusted healthcare solutions.

Job Summary

Cardinal Health is seeking a driven, self-starter and highly skilled manager with expertise in healthcare regulatory compliance, including third party billing and reimbursement.  This role will be responsible for providing sound compliance advice and guidance to Cardinal Health’s At-Home Solutions (“AHS”) business. At Home Solutions is a leading home healthcare medical supplies provider serving people with chronic and serious health conditions in the United States.  The AHS business unit is comprised of four complementary business units: (1) Edgepark Medical Supplies, (2) Advanced Diabetes Supply Group, (3) Cardinal Health at-Home, a direct-to-home medical supplies distributor, and (4) Velocare, a supply chain network and last-mile fulfillment solution.

Reporting to the Director of Ethics & Compliance – At-Home Solutions, this role is responsible for ensuring the company operates in line with compliance standards. Key duties involve managing billing audits for durable medical equipment, prosthetics, orthotics, and supplies(“DMEPOS”), including detection and correction of documentation, coding, identifying potential errors and/or medical necessity of items billed. And ensuring payor requirements are fulfilled. The position also includes sharing audit findings with management, recommending training and solutions for issues found, supporting audit diligence and integration efforts, and overseeing an audit team dedicated to billing processes and audits.

Candidates should be adaptable, team-oriented, collaborative, and capable of working independently in a fast-paced setting with oversight from Ethics and Compliance leadership. This role will work closely with various cross-functional colleagues across the AHS order entry and revenue cycle management team, Legal, the Enterprise Privacy Office, and other internal teams to identify and address potential issues and risks and help Cardinal Health comply with the evolving laws and regulations applicable to the AHS business.

Responsibilities

• Provides compliance-related expertise and advice to Revenue Cycle management and other business teams with respect to day-to-day operations, including, without limitation, advice on Medicare and Medicaid DMEPOS supplier billing requirements, local coverage determination requirements, Medicare DMEPOS Supplier and Quality Standards, and other payor requirements.
• Serves as liaison with third party government contractors conducting audits as well as managing a small internal billing compliance team.
• Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to DMEPOS supplies billing and/or medical necessity reviews and other high-risk areas as appropriate.
• Leads data analytics on audit outcomes; identifies and reviews audit trends and makes recommendations on remedial action to address such trends.
• Evaluates the appropriateness of items billed based on supporting record documentation and ensures documentation conforms to CMS and/or payor requirements.
• Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
• Collaborates with the Legal team to conduct risk assessments to define audit priorities based on previous audit findings, management priorities, national normative data, CMS initiatives, OIG work plans and advisories and healthcare industry best-practices.
• Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.
• Plans and conducts regular compliance training for Revenue Cycle team members, as needed.
• Provides feedback and training for staff regarding potential claim deficiencies
• Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.
• Supports the overall workplan of the Compliance Department.
• Interacts with subordinates, peers, customers and suppliers at various management levels and may interact with senior management.
• Interactions normally involve resolution of issues related to operations and/or projects
• Gains consensus from various parties involved. 
• Other duties as assigned.

Qualifications

• 8-12 years of experience, preferred
• Bachelor’s degree in related field, or equivalent work experience, preferred.
• Familiarity with key laws, regulations, and sub-regulatory guidance that affects DMEPOS businesses and by federal and state government programs, for example, fraud and abuse (Anti-Kickback Statute, False Claims Act, Civil Monetary Penalties Law, Stark, and Beneficiary Inducement Statutes); works collaboratively with the Legal Team to help advise the At-Home Solutions business
• 7+ years of related work experience supporting compliance programs in DMEPOS suppliers, coding and medical necessity expertise, preferred.
• Related work experience with Brightree, preferred.
• Expert-level knowledge of Medicare and Medicaid billing and documentation requirements; healthcare compliance audit methodology, principles and techniques; CMS Medicare manuals; DMEPOS reimbursement and repayment; confidentiality standards.
• Ability to interpret and apply coverage determination, documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
• Strong attention to detail with an emphasis on organizational and analytical skills.
• Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
• Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership.
• Prompt and efficient ability to manage shifting priorities, demands and timelines using analytical and problem-solving capabilities.
• Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
• Excellent problem-solving skills with self-starter qualities, enabling management of responsibilities to function effectively and efficiently.
• Strong communication and presentation skills.
• Proficiency in MS Word, Excel, PowerPoint, and Outlook.

What is expected of you and others at this level

• Manages department operations and supervises professional employees, front line supervisors and/or business support staff.
• Participates in the development of policies and procedures to achieve specific goals.
• Ensure employees operate within guidelines.
• Decisions have impact on work processes, and outcomes.
• Ability to work in a team environment with the ability to handle multiple audits at once.
• Knowledge of claim lifecycles and revenue cycle management.
• Knowledge of CMS Local Coverage Determination policies, and various payor requirements.
• Professional auditing experience.
• Exceptional Customer Service Skills.  
• Proven interpersonal communication skills.
• Excellent time management, personal integrity and ability to maintain confidentiality

Anticipated salary range: $105,500-$150,100
Bonus eligible: Yes
Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
•    Medical, dental and vision coverage
•    Paid time off
•    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: 03/13/2026 *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