Medical Billing & Denial Specialist (DME)

Jandbmedical; Northern (KY); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Benefits after 30 days

PTO after 90 days

Bonus opportunities

Job summary

Jandbmedical is seeking an Experienced Medical Billing & Denial Specialist (DME) to analyze, appeal, and resolve insurance denials across Medicare, Medicaid, and commercial claims. This remote role leverages the Universal Software Solutions HDMS platform and requires strong regulatory knowledge.

Responsibilities include denial management, crafting well-researched appeals, validating CPT/DRG coding, and collaborating with coders and management to improve AR metrics while maintaining compliance.

Qualifications

• 3+ years of dedicated DME billing and insurance collections experience.
• Proficient in HDMS or similar DME enterprise billing software.
• Experience managing Medicare, Medicaid, and commercial claims.
• Strong Excel skills and EDI experience.
• BYOD setup required.

Responsibilities

• Analyze, appeal, and resolve insurance claim denials for DME.
• Navigate HDMS to monitor denial workflows and processing.
• Draft logical appeals based on contracts and medical records.
• Identify payer denial trends and report findings to management.
• Collaborate with coders and management to resolve disputes and improve AR metrics.

Skills

HDMS navigation

Payer denial management

Excel (advanced)

EDI transmissions

Insurance claims knowledge

Education

High school diploma or GED

Tools

HDMS

CMS provider portals

Job description

All Jobs > Medical Billing & Denial Specialist (DME)

Medical Billing & Denial Specialist (DME)
Fully Remote • AL,FL, GA, IN, LA, MS, NC, SC, TN, TX, VA, & WV

HIRING REMOTE EXPERIENCED BILLERS IN THE FOLLOWING STATES: AL,FL, GA, IN, LA, MS, NC, SC, TN, TX, VA, & WV

MI RESIDENTS WITHIN 40 MILES OF 48393 WILL BE HYBRID

Are you an Experienced Medical Biller LOOKING FOR GROWNING COMPANY WITH ROOM FOR ADVANCEMENT?

- Full Benefits after 30 Days!! PTO after 90 Days! and MORE!!!!

The Medical Billing & Denial Specialist is responsible for analyzing, appealing, and resolving insurance claim denials for Durable Medical Equipment (DME). Utilizing the Universal Software Solutions HDMS platform, this role requires deep regulatory knowledge to craft effective, logic-based written appeals that maximize reimbursement. The ideal candidate takes an analytical approach, identifying payer denial trends to proactively prevent recurring billing errors.

Denial Management & System Workflows

• HDMS Queue Navigation: Utilize Universal Software Solutions HDMS to monitor, prioritize, and process daily denial workflows and collections worksheets.
• Audit & Correct: Review denied claims within HDMS for coding accuracy and execute required corrections before submission.
• Appeal Excellence: Draft well-researched, logical written appeals based on strict contract, coding, and medical record reviews.
• Payer Navigation: Resolve claim bottlenecks across commercial, Medicare, Medicaid, and Medicare Advantage plans.
• No-Response Claims: Investigate outstanding claims with zero payer response to verify receipt and accelerate processing.

Root-Cause Analysis & Strategy

• Trend Identification: Detect systemic payer denial patterns within HDMS data streams and communicate findings to management to prevent future errors.
• Policy Tracking: Monitor regulatory changes, Medicare Local Coverage Determinations (LCDs), and individual payer policy shifts.
• Team Knowledge Share: Inform internal team members of updated payer guidelines and assist with peer education as needed

Operational Support

• Internal Collaboration: Partner with coders, billers, and management to resolve cross-departmental coding disputes.
• Quality Assurance: Achieve designated organizational goals regarding error-free transactions, compliance metrics, and aging AR timelines.
• Escalation Support: Act as the primary point of contact for complex, unresolved billing and denial challenges.

Position Type & Schedule

• Status: Full-time (40 hours per week).
• Schedule: Monday through Friday, Day Shift.
• Flexibility: Occasional evening and weekend work may be required based on operational demands.

Requirements

Minimum Qualifications

• Experience: 3+ years of dedicated DME billing, coding, and insurance collections experience.
• Software Proficiency: 1+ years of hands-on experience navigating Universal Software Solutions HDMS (or similar broad-scale DME enterprise billing software).
• Payer Knowledge: Proven background managing Medicare, Medicaid, and commercial claims.
• Technical Skills: Experience with Electronic Data Interchange (EDI) transmissions and advanced Excel skills.
• Education: High school diploma or GED equivalent.

Preferred Qualifications

• Advanced HDMS Skills: Familiarity with the HDMS workspace, StowPoint document management, or automated workflow tools.
• DMEPOS Expertise: Deep familiarity with DMEPOS fee scheduling files, laws, and compliance regulations.
• Regional Guidelines: Strong working knowledge of Multi-State Medicare Local Coverage Determinations (LCDs).
• Portal Proficiency: Hands-on experience navigating CMS and EPS provider portals.

Technical Infrastructure (BYOD)

• Equipment: This position requires a Bring Your Own Device (BYOD) setup. Equipment is not provided.
• Hardware: You must own and maintain a reliable computer capable of securely running healthcare software.

Other Duties

All other duties as assigned by management.