Durable Medical Equipment Biller

Position Summary: 

Our company is seeking a talented and experienced (Durable Medical Equipment) DME Biller. An Incumbent will be responsible to Manage the billing till the reimbursement process of medical equipment provided to customers and patients. This role will require a person to ensure accuracy on records, documentation, reporting, claims submission and compliance with the insurance and regulatory requirements and company policies.

Key Responsibilities:

Claims Submission:

• Prepare and submit claims for DME services and products to Medicare, Medicaid, and private insurance payers.
• Ensure proper coding with HCPCS codes, ICD-10 diagnosis codes, and modifiers specific to DME billing.

Verification of Insurance Eligibility:

• Verify patient coverage and pre-authorize DME services as required.
• Communicate with insurance carriers to confirm coverage guidelines for DME items (e.g., wheelchairs, Incontinence, CPAP machines).

Claims Management:

• Follow up on submitted claims to ensure timely payment.
• Resolve claim denials and rejections by identifying issues, submitting corrected claims, and appealing if necessary.
• Track claims status and maintain detailed billing logs.

Documentation Management:

• Ensure all required documentation, such as CMNs (Certificate of Medical Necessity), prescriptions, and supporting medical records, are complete and accurate.
• Coordinate with clinical teams to obtain missing documentation.

Accounts Receivable (A/R) Follow-Up:

• Monitor and collect outstanding balances from insurance payers and patients.
• Manage aging reports to reduce unpaid claims.

Compliance and Regulations:

• Ensure all DME billing adheres to Medicare guidelines, HIPAA, and other payer-specific rules.
• Stay updated on policy changes, especially Medicare DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) regulations.

Customer Service:

• Communicate with patients to clarify insurance coverage, payment responsibilities, and outstanding balances.
• Address patient inquiries regarding billing and provide detailed explanations.

Job Specifications/Requirements:

Education: High school diploma (required); associate degree or certification in medical billing/coding preferred.

Attention to Detail: Accuracy in coding, documentation, and data entry to minimize denials.

Communication Skills: Effective communication with patients, insurance carriers, and clinical teams 

Certifications: Certification as a Certified Professional Biller (CPB) or DME Specialist (CDME) is a plus.

Experience: 2–4 years in, DME billing.

Technology: Must have experience with Brightree DME Billing Software. We will perform a skill assessment on Brightree.

JOIN THE TEAM!