Payer Audit and Appeal Spec II

ABC Medical; Richardson (TX); On-site; USD 28,000 - 32,000; Full time

Benefits offered by this job

Competitive pay

Paid time off

Health insurance

Life insurance

401(k) retirement plan

Parental leave

Disability coverage

Job summary

ABC Medical is seeking a Payer Audit and Appeal Specialist to manage denial-related workflows for Medicare, Humana Medicare and commercial payer claims. You will gather medical records, respond to audits, and ensure timely submission.

The role requires 3–5 years of DMEPOS Medicare experience, strong analytical and communication skills, and familiarity with Brightree. Office location is South Pittsburg, TN with five days in the office.

Qualifications

• Analytical skills and attention to detail are required.
• Excellent verbal and written communication skills.
• 3–5 years of DMEPOS Medicare experience.

Responsibilities

• Respond to all payer audits and ensure timely and accurate submission.
• Gather and submit required documentation through the appeals process.
• Follow up on audit submissions to ensure timely responses and outcomes.
• Identify denial reasons and request documents needed to appeal claims.
• Collaborate with Referral Management to obtain supporting records.
• Maintain knowledge of Medicare appeals process and LCDs and communicate updates.
• Provide feedback to leadership for reports and process improvements.

Skills

Analytical skills

Attention to detail

Excellent verbal and written C skills

Education

High School Diploma

Bachelor's Degree

Tools

Brightree

Microsoft Excel

Job description

ABC Home Medical Supply, Inc is one of the nation's leading urological supply providers and serves as a one-stopshop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy. ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.

Location:

Port Saint Lucie

ABC Medical is one of the nation's leading urological supply providers and serves as a one-stopshop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy. ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.

Work Location:

South Pittsburg, TN (5 days in office)

Overview:

The Payer Audit and Appeal Specialist is responsible to complete the daily activities including all medical document requests and appeals for denied Medicare, Humana Medicare, and Commercial payer claims related to evidence of medical necessity.

Responsibilities:

• The Payer Audit and Appeal Specialist responds to all payer audits and ensures timely and accurate submission.
• Gathers and submits required documentation, forms, etc. through the established appeals process within a timely manner.
• Conducts follow up activity related to audit and appeal submissions to ensure timely responses and outcomes.
• Accurately identify the denial reasons and request documents needed to appeal the claims through concise, detailed and accurate task requests.
• Collaborates with the Referral Management team to obtain supporting medical records.
• Maintains a strong working knowledge of the Medicare's appeals process and LCDs, stays up to date on all Medicare LCD changes as well as Third Party insurances and communicates updates and changes proactively.
• Provide feedback to the leadership team regarding reports and may assist with conducting analysis for the identification and resolution of trending of patterned denials and overall continued process improvement for management.

Minimum Qualifications:

• High School Diploma
• Analytical skills required, with strong attention to detail, highly organized
• Excellent verbal and communication skills required
• Detail oriented individual with 3-5 years of DMEPOS Medicare experience

Preferred Qualifications:

• 3-5 years of Medicare Medical billing
• Experience & knowledge of Brightree billing software
• Proficiency with Microsoft Office including Excel

Bachelor's Degree

EOE Statement:

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Team members shall adhere to high standards of ethical conduct and will comply with and assist the Company in complying with all policies and applicable laws and regulations.

Accommodations Statement:

ABC Medical endeavors to make www.abc-med.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the ABC Medical HR Department at [e-mail]. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

Our Total Rewards package in aggregate is above market and includes competitive pay, paid time off programs, peer-to-peer recognition, health and life insurance, wellness programs and incentives, generous retirement savings.

• The anticipated base salary range for this position is $20.00 - $23.00. The actual salary varies based on applicant's location, education, experience, skills, abilities, and other legitimate business factors.
• The Company's health and welfare benefits include medical, prescription, dental, vision, spending/savings accounts, disability, company paid parental leaves, statutory leaves/disability programs, accident, and life.
• The Company's 401(k) Retirement Savings Plan includes: auto-enrollment, ROTH, vesting and eligible participants "safe harbor" matching contributions.
• The Company's paid time off benefits include: 8 paid holidays, paid vacation based on length of service and exempt/non-exempt status, and sick days based on statutory requirements and/or exempt/non-exempt status.