Medical Billing Specialist - DME

Quest Health Solutions LLC; Birmingham (AL); On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

Life Insurance coverage

Paid time off and Holiday Pay

401K with company match option

Growth opportunities

Job summary

Quest Health Solutions LLC is seeking a Medical Billing Specialist - DME to oversee revenue cycle activities, focusing on escalations, Medicare appeals oversight, and coordination with the billing partner.

You will review Medicare LCD guidelines, manage AR, denials, write-offs, and help patients with billing questions; experience with Brightree preferred.

Qualifications

• Experience in revenue cycle management with focus on DME and Medicare billing.
• Knowledge of LCD guidelines and Medicare claim requirements.
• Ability to review documentation for compliance.

Responsibilities

• Research and resolve outstanding AR balances.
• Review denials reports and track resolutions.
• Approve write-offs and manage related approvals.
• Handle AR tasks for denied or delayed claims.
• Oversee RCM intake and escalations for billing issues.
• Review Medicare appeals for accuracy and guide strategy.
• Assist patients with billing inquiries and coordinate resolutions.
• Identify opportunities to improve revenue cycle processes.

Skills

DME & Medicare Billing Expertise

Technical Knowledge of Brightree

Problem-Solving Ability

Communication Skills

Organizational Skills

Tools

Brightree

Job description

Overview of the Role

The Medical Billing Specialist - DME is responsible for managing key aspects of the revenue cycle process within Quest Health Solutions. While a third-party billing company handles initial billing functions, this role focuses on escalations, oversight, and specialized tasks to ensure accurate billing, effective denial management, and smooth coordination across departments. The RCM Specialist plays a vital role in maximizing revenue, supporting compliance, and enhancing overall operational efficiency.

Essential Duties and Responsibilities

Accounts Receivable (AR) & Billing

• Handling AR tasks, including research and resolution of outstanding balances.


• Conduct denials report reviews.


• Manage write-off approvals.


• Handle AR tasks related to denied or delayed claims.

Resupply Management Order Escalations

• Manage RCM intake and order escalations involving AR and billing-related issues.

Medicare Appeals Oversight

• Review Medicare appeals prepared by the billing company for accuracy.


• Provide guidance and direction to the billing company on appeal content and strategy when needed.

Customer Service

• Perform patient outreach to obtain updated information when required to resolve billing or order issues.


• Support patients in understanding billing-related inquiries and coordinate resolutions with internal teams.

Process Improvement

• Identify opportunities for process improvements within the revenue cycle to enhance efficiency, accuracy, and compliance.

Requirements

What You’ll Bring

• DME & Medicare Billing Expertise: Previous experience in a revenue cycle management role with a strong focus on Durable Medical Equipment (DME). In-depth knowledge of Medicare billing processes, claim requirements, and LCD (Local Coverage Determination) guidelines, with the ability to review documentation for compliance.


• Technical Knowledge: Familiarity with Brightree and core revenue cycle functions, including AR management, billing workflows, and denial resolution.


• Problem-Solving Ability: Demonstrated capacity to research, analyze, and resolve complex billing issues and denials effectively and efficiently.


• Communication Skills: Strong verbal and written communication skills to collaborate with internal teams, patients, physicians’ offices, and insurance providers.


• Organizational Skills: Excellent organizational skills with the ability to manage multiple priorities, meet deadlines, and ensure timely resolution of escalations.

Benefits

• Medical, Dental, and Vision Insurance


• Life Insurance coverage


• Paid time off and Holiday Pay


• 401K with company match option


• Growth opportunities