DME Billing and Claims Specialist

Position Summary:

The DME Medical Collections Specialist position resolves issues with unpaid insurance claims for an assigned client load. It researches incoming denials from insurance companies, initiates the collection process through telephone contacts, letters, contracts, websites, etc. and research payor and government websites and/or medical resources to identify payor claim requirements to resolve open accounts receivable and works to minimize write-offs by exhausting all resolution options. It also leverages technology to identify and report process inefficiencies and makes recommendations for continuous improvement and opportunities that will enhance revenue flow.

DUTIES & RESPONSIBILITIES:

• Reviewing open AR for your designated client load to evaluate what is needed to collect the outstanding cash.
• Work independently to identify and resolve reasons for denials, rejections and claims with no response in the most efficient manner possible.
• Understand, locate, and review payer websites and manuals for guidance and resolution.
• Evaluate high touch claims and Tier 2 claims and provide feedback to the team working the first touch on errors made or where feedback can be given to eliminate touches on the claim.
• Ability to review and identify patterns of price table issues and escalate to resolve them according to contract or payer guidelines.
• Ability to review and identify patterns with payers and non-payment or delayed payment. Be able to summarize and escalate in the correct manner.
• Work with payer representatives or provider representatives to identify and resolve outstanding issues, and evaluating volume to find the most efficient way to resolve the outstanding issues or start a project with the payer representatives.

QUALIFICATIONS & EXPERIENCE:

• Must have experience with working with DME, Durable Medical Equipment claims with Complex Rehab experience. CRT.
• Must have experience working with insurance carriers to resolve or address denied or partially paid DME, Durable Medical Equipment claims.
• Atlas Software experience preferred.
• Able to effectively work denials received from Insurance Payers and review an Explanation of Benefit or Remittance Advice.
• Able to utilize software efficiently by submitting claims, working payer rejections, and understanding the industry’s HCPCS and modifier combinations and diagnoses coding.

ACU-Serve is an equal opportunity employer and is committed to providing a workplace that is free of discrimination of all types and promotes diversity, inclusion, and respect. We prohibit discrimination and harassment of any kind based on race, color, sex, gender, religion, creed, sexual orientation, national origin, age, disability, genetic information, pregnancy, veteran status, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization. ACU-Serve makes hiring decisions based solely on qualifications, merit, and business needs at the time.

Originally posted on Himalayas