DME Billing and Claims Specialist

ACU-Serve; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

ACU-Serve is seeking a DME Billing and Claims Specialist to resolve unpaid insurance claims for a designated client load. The role researches denials, initiates collection actions, and reviews payor guidelines to minimize write-offs.

Candidates should have DME/CRT experience, familiarity with HCPCS/modifier coding, and Atlas Software, with ability to navigate payer portals and Remittance Advice to ensure timely cash flow.

Qualifications

• Experience with DME/ Durable Medical Equipment claims and Complex Rehab (CRT).
• Experience working with insurance carriers to resolve denied or partially paid DME claims.
• Atlas Software experience preferred.
• Able to review EOB/RA and utilize software for submitting claims and tracking denials.
• Familiarity with HCPCS modifiers and diagnoses coding.

Responsibilities

• Review open AR for designated client load to determine steps to collect outstanding cash.
• Independently identify and resolve reasons for denials and non-responses efficiently.
• Review payer websites and manuals for guidance and resolution.
• Evaluate high-touch claims and provide feedback to reduce repeat touches.
• Identify patterns in price tables and payer guidelines and escalate as needed.
• Summarize payer patterns and coordinate with payer/provider representatives to resolve issues.

Skills

DME Claims

Denials resolution

HCPCS coding

Complex Rehab

Tools

Atlas Software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

DME Billing and Claims Specialist

Operations Clerical Remote, US

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 elevate 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 consolidate 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.