Medicare Payer Appeals & Audit Specialist II

Hollister Incorporated; South Pittsburg (TN); On-site; USD 28,000 - 32,000; Full time

Benefits offered by this job

Health & welfare benefits

Paid time off programs

401(k) with company match

Job summary

ABC Home Medical Supply, Inc is seeking a Payer Audit and Appeal Specialist to handle daily medical document requests and appeals for Medicare and commercial payer claims related to medical necessity. This role is located in South Pittsburg, TN (5 days in office).

You will respond to payer audits, gather documentation, and ensure timely submissions while maintaining knowledge of Medicare processes and LCD changes. Strong analytical and communication skills are essential.

Qualifications

• 3–5 years of DMEPOS Medicare experience
• Analytical with strong attention to detail and highly organized
• Excellent verbal and written communication skills

Responsibilities

• Respond to all payer audits and ensure timely and accurate submission
• Gather and submit required documentation through the appeals process
• Conduct follow-up activity related to audit submissions for timely responses
• Identify denial reasons and request documents to appeal claims
• Collaborate with Referral Management to obtain medical records
• Stay updated on Medicare LCD changes and other insurances

Skills

Analytical

Verbal & written communication

Detail oriented

Education

High School Diploma

Bachelor's Degree

Tools

Brightree billing software

Microsoft Office (Excel)

Job description

ABC Home Medical Supply, Inc is seeking a Payer Audit and Appeal Specialist to handle daily medical document requests and appeals for Medicare and commercial payer claims related to medical necessity. This role is located in South Pittsburg, TN (5 days in office).

You will respond to payer audits, gather documentation, and ensure timely submissions while maintaining knowledge of Medicare processes and LCD changes. Strong analytical and communication skills are essential.