DME Billing Specialist

Guardian Home Healthcare, Inc.; Raleigh (NC); On-site; USD 42,000 - 64,000; Full time

Job summary

Guardian Home Healthcare, Inc. in Raleigh, NC seeks a detail-oriented DME Billing Specialist to manage end-to-end durable medical equipment billing. You will ensure timely claim submission, verify insurance, resolve denials, and maintain compliance with payer guidelines.

The role requires knowledge of Medicare/Medicaid, HCPCS/ICD-10/CPT coding, and proficiency with EMR/EHR systems, billing software, and Microsoft Office. Strong communication and organizational skills are essential.

Qualifications

• High school diploma or equivalent.
• 1–2 years of medical billing or DME billing experience.
• Knowledge of Medicare, Medicaid, and commercial insurance billing procedures.
• Familiarity with HCPCS, ICD-10, and CPT coding.
• Proficiency in billing software, Microsoft Office Suite, and EMR/EHR systems.

Responsibilities

• Process and submit DME claims accurately and promptly.
• Verify patient insurance eligibility, benefits, and authorization requirements.
• Review physician orders and documentation for billing compliance.
• Monitor claim status and follow up on unpaid or denied claims.
• Resolve billing discrepancies and initiate appeals when necessary.
• Post payments, adjustments, and reconcile patient accounts.
• Communicate with insurers, patients, and providers regarding billing matters.
• Maintain accurate billing records and account status.
• Ensure compliance with Medicare, Medicaid, and commercial policies.
• Assist with accounts receivable management and collections.
• Prepare and maintain reports on billing performance and reimbursement trends.

Skills

Attention to detail

Analytical skills

Organizational skills

Communication skills

Time management

Customer service

Data entry

Education

High school diploma or equivalent

Associate degree in Healthcare Administration, Medical Billing, or related field

Tools

Billing software

EMR/EHR systems

Microsoft Office

Job description

DME Billing Specialist

Location: Raleigh, NC

Job Summary:

We are seeking a detail-oriented and experienced DME Billing Specialist to join our team. The ideal candidate will be responsible for managing the billing process for Durable Medical Equipment (DME), ensuring timely claim submission, payment processing, denial resolution, and compliance with payer guidelines. This role requires strong knowledge of insurance billing, Medicare and Medicaid regulations, and excellent customer service skills.

Key Responsibilities:

• Process and submit claims for Durable Medical Equipment (DME) accurately and promptly.
• Verify patient insurance eligibility, benefits, and authorization requirements.
• Review physician orders and supporting documentation to ensure billing compliance.
• Monitor claim status and follow up on unpaid, denied, or rejected claims.
• Resolve billing discrepancies and initiate appeals when necessary.
• Post payments, adjustments, and reconcile patient accounts.
• Communicate with insurance carriers, patients, and healthcare providers regarding billing matters.
• Maintain accurate records of billing activities and account status.
• Ensure compliance with Medicare, Medicaid, commercial insurance, and company policies.
• Assist with accounts receivable management and collections activities.
• Prepare and maintain reports related to billing performance and reimbursement trends.

Qualifications:

• High school diploma or equivalent.
• Minimum of 1-2 years of medical billing or DME billing experience.
• Knowledge of Medicare, Medicaid, and commercial insurance billing procedures.
• Familiarity with HCPCS, ICD-10, and CPT coding.
• Proficiency in billing software, Microsoft Office Suite, and electronic medical records (EMR/EHR) systems.
• Strong analytical, organizational, and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities while meeting deadlines.

Preferred:

• Associate degree in Healthcare Administration, Medical Billing, or a related field.
• Certified Professional Biller (CPB) or related certification.
• Experience working in a DME supplier, home medical equipment company, or healthcare setting.

Skills and Competencies:

• Attention to detail and accuracy.
• Insurance verification and authorization management.
• Claims processing and denial resolution.
• Time management and organization.
• Customer service excellence.
• Data entry and record maintenance.
• Knowledge of healthcare regulations and compliance standards.