[Hiring] DME Billing and Claims Specialist @ACU-Serve

Role Description

The DME Medical Collections Specialist position resolves issues with unpaid insurance claims for an assigned client load. It researches incoming denials from insurance companies, initiates the collection process through various means, and works to minimize write-offs by exhausting all resolution options. The role also leverages technology to identify and report process inefficiencies and makes recommendations for continuous improvement.

• Reviewing open AR for your designated client load to evaluate what is needed to collect the outstanding cash.
• Work independently to identify and resolve reasons for denials, rejections, and claims with no response in the most efficient manner possible.
• Understand, locate, and review payer websites and manuals for guidance and resolution.
• Evaluate high touch claims and Tier 2 claims and provide feedback to the team on errors made or where feedback can be given to eliminate touches on the claim.
• Ability to review and identify patterns of price table issues and escalate to resolve them according to contract or payer guidelines.
• Ability to review and identify patterns with payers and non-payment or delayed payment, summarizing and escalating in the correct manner.
• Work with payer representatives or provider representatives to identify and resolve outstanding issues, evaluating volume to find the most efficient way to resolve the outstanding issues.

Qualifications

• Must have experience with working with DME, Durable Medical Equipment claims with Complex Rehab experience.
• Must have experience working with insurance carriers to resolve or address denied or partially paid DME claims.
• Atlas Software experience preferred.
• Able to effectively work denials received from Insurance Payers and review an Explanation of Benefit or Remittance Advice.
• Able to utilize software efficiently by submitting claims, working payer rejections, and understanding the industry’s HCPCS and modifier combinations and diagnoses coding.

Company Description

ACU-Serve is an equal opportunity employer and is committed to providing a workplace that is free of discrimination of all types and promotes diversity, inclusion, and respect. We prohibit discrimination and harassment of any kind based on race, color, sex, gender, religion, creed, sexual orientation, national origin, age, disability, genetic information, pregnancy, veteran status, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization. ACU-Serve makes hiring decisions based solely on qualifications, merit, and business needs at the time.