Submit DME claims accurately and timely to Medicare, Medicaid, TRICARE, and commercial payers
Ensure proper use of HCPCS codes , modifiers, units, and diagnosis codes
Verify documentation requirements including prescriptions, CMNs, medical necessity, and proof of delivery (POD)
Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs)
Post payments, adjustments, and denials accurately
Research, correct, and resubmit denied or rejected claims
Manage payer follow-up for unpaid or underpaid claims
Identify trends in denials and provide recommendations for process improvement
Prepare and submit appeals with supporting documentation
Monitor accounts receivable (AR) aging and prioritize follow-up
Communicate with payers, clearinghouses, and internal teams to resolve issues
Maintain accurate patient and payer records within the billing system
Ensure compliance with CMS, Medicare, Medicaid, and payer-specific billing guidelines
Stay up-to-date on changes in payer policies, fee schedules, and regulations
Maintain HIPAA compliance and patient confidentiality at all times

2-5 yrs. experience independently verifying medical insurance/coverage with all major insurance carriers.
2 plus years of billing and coding experience.
High School Diploma or equivalent (G.E.D.) and 2-5 years’ insurance related experience.
Excellent verbal and written communication skills.
Strong inter-personal skills with the ability to effectively interact with co-workers and customers.
Ability to multitask and prioritize assignments.
Problem solving skills in standardized situations.
Strong attention to detail with proven ability to work accurately and efficiently.
Must be organized, flexible and adaptable to changing requests and requirements.
High School Diploma or equivalent (G.E.D.)
Experience using e-mail system for ongoing communication.
Ring Central experience a plus.
Salesforce and Brightree experience a plus.

DME Billing Specialist

Key skills