State Licensed Audit Policy Analyst

Job Summary

As the subject matter expert in post-acute services, the remote State Licensed Audit Policy Analyst will develop and maintain audit concepts for durable medical equipment, home health, and home infusion therapy claims while collaborating with cross-functional teams to ensure compliance with coding standards and payer policies.

Key responsibilities

• Develop and update post-acute audit concepts based on regulatory changes and client-specific policies
• Perform quality assurance reviews and validate audit concepts against billing rules and guidelines
• Manage multiple audit workflows, ensuring consistent application of policies across auditing platforms

Required qualifications

• Bachelor's degree in nursing, health administration, business, or a related field, or equivalent experience
• Minimum 5+ years of experience in DME, home health, and/or home infusion therapy with a focus on payment integrity and claims auditing
• Registered Nurse or Certified Coder holding a nationally recognized credential (RHIA, RHIT, AHIMA, AAPC, or equivalent) required
• Expert knowledge of post-acute coding systems and payment methodologies, including ICD-10-CM and HCPCS Level II
• Strong experience in data utilization and statistical analysis related to audit concepts