Remote DME Medical Biller 259553

Medix™; Missouri; On-site; USD 52,000 - 80,000; Full time

Job summary

Medix™ seeks an experienced DME Billing Specialist focused on MO HealthNet to manage claims, denials, and cash collections for enteral nutrition, incontinence supplies, and urological products.

You will serve as the Missouri DME billing SME, ensure HCPCS coding accuracy, verify eligibility, and resolve complex payer issues while collaborating with intake, documentation, and finance teams to optimize revenue cycle performance.

Qualifications

• Experience in Durable Medical Equipment billing and revenue cycle management.
• Specialized MO HealthNet (Missouri Medicaid) regulations, billing guidelines, and claim submission processes.
• Proficiency in reviewing EOBs, claim denials, rejection reports, and online payer portals.
• Strong understanding of HCPCS coding, modifiers, and medical necessity documentation for DME supplies.
• Excellent problem-solving, organizational, and communication skills.

Responsibilities

• Oversee full-cycle DME claim submission, error correction, rebilling, appeals, and payer follow-up, focusing on MO HealthNet claims.
• Review aging accounts receivable to accelerate collections and reduce outstanding balances.
• Identify root causes of denials, rejections, underpayments, authorization discrepancies, and coding/billing errors for timely resolution.
• Apply payer guidelines regarding HCPCS coding, modifiers, unit maximums, quantity limits, medical necessity documentation, and supporting clinical records.
• Verify patient eligibility, plan coverage, COB, and identify the correct primary/secondary billing pathways.
• Research MO Medicaid managed care plans and waivers for complex claims issues.
• Analyze EOBs, remittance advice, and payer portal updates to determine claim statuses and take corrective actions.
• Coordinate with intake, prior authorization, medical documentation, and customer service teams to resolve payment barriers and streamline workflow.
• Serve as internal expert for Missouri DME billing challenges and assist in cross-training department members.
• Maintain meticulous records of claim activity and communicate recurring trends to leadership.
• Suggest workflow improvements to prevent recurring denials and payment delays.

Skills

DME billing

MO HealthNet regulations

payer claims follow-up

HCPCS coding knowledge

communication skills

Tools

Brightree

Job description

Qualified candidates must live in the state of Missouri!

Position Summary

We are seeking a highly experienced DME Billing Specialist with deep expertise in MO HealthNet (Missouri Medicaid) to join our team. In this role, you will be responsible for managing claims, resolving complex billing issues, reducing outstanding accounts receivable, and optimizing overall cash collections.

As the department's primary subject matter expert for Missouri DME billing, you will focus extensively on claim categories including enteral nutrition, feeding equipment and supplies, incontinence products, and urinary catheters. The ideal candidate brings a proven track record of success navigating MO HealthNet fee-for-service, Missouri Medicaid managed care organizations, state waiver programs, and major commercial payers.

Key Responsibilities

• Claims Management & Follow-up: Oversee full-cycle DME claim submission, error correction, rebilling, appeals, and payer follow-up, with a primary concentration on MO HealthNet claims.
• A/R & Collections Optimization: Continuously review aging accounts receivable, prioritizing claims to accelerate collections and significantly lower outstanding balances.
• Denial & Rejection Resolution: Identify root causes of denials, rejections, underpayments, authorization discrepancies, and coding/billing errors to ensure timely resolution.
• Compliance & Payer Guidelines: Accurately apply payer-specific guidelines regarding HCPCS coding, modifiers, unit maximums, quantity limits, medical necessity documentation, and supporting clinical records.
• Eligibility & Coverage Verification: Verify patient eligibility, plan coverage, coordination of benefits (COB), and identify the correct primary/secondary billing pathways.
• Medicaid Managed Care & Waivers: Research and resolve complex claims issues involving Missouri Medicaid managed care plans and state waiver programs.
• Remittance & Portal Analysis: Analyze EOBs, remittance advice, and payer portal updates to determine claim statuses and execute necessary corrective actions.
• Cross-Departmental Collaboration: Coordinate closely with intake, prior authorization, medical documentation, and customer service teams to resolve payment barriers and streamline workflow.
• Department Resource & Training: Serve as the internal go-to expert for Missouri DME billing challenges and assist in cross‑training department team members.
• Documentation & Reporting: Maintain meticulous records of claim activity and follow-up efforts, communicating recurring trends or systemic collection hurdles to leadership.
• Process Improvement: Track payer policy changes and recommend workflow enhancements to proactively prevent recurring denials and payment delays.

Key Payer Experience

• Medicaid / Managed Care: MO HealthNet (Fee-for-Service), Home State Health, Show Me Healthy Kids, Healthy Blue, and UnitedHealthcare Community Plan.
• Commercial Payers: Blue Cross and Blue Shield of Kansas City, UnitedHealthcare, Aetna, Cigna, and applicable regional commercial plans.

Qualifications & Requirements

Required Skills & Experience

• Proven experience in Durable Medical Equipment (DME) billing and revenue cycle management.
• Specialized expertise in MO HealthNet (Missouri Medicaid) regulations, billing guidelines, and claim submission processes.
• Demonstrated proficiency in reviewing and analyzing EOBs, claim denials, rejection reports, and online payer portals.
• Strong understanding of HCPCS coding, modifiers, and medical necessity documentation requirements for DME supplies.
• Excellent problem-solving, organizational, and communication skills.

Preferred Qualifications

• Hands‑on experience with Brightree or comparable DME/HME billing software platforms.
• Prior experience managing claims for enteral nutrition, incontinence supplies, or urological products.