DME Medical Billing and Collections Specialist

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 telephone contacts, letters, contracts, websites, etc. and research payor and government websites and/or medical resources to identify payor claim requirements required to resolve open accounts receivable and works to minimize write-offs by exhausting all resolution options. It also leverages technology and identifies and reports process inefficiencies and make recommendations for continuous improvement and opportunities that will enhance revenue flow.

DUTIES & RESPONSIBILITIES:

• 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.
• Work via website, phone, fax, and any manner necessary to resolve the outstanding AR in the most efficient way 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 working the first touch 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. Be able to summarize and escalate in the correct manner.
• Exercise good time management skills to balance the workload between multiple clients and payers and complete goals timely.
• 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 or start a project with the payer representatives.
• Remain productive throughout the workday and communicate if more work is needed.
• Communicate effectively when additional training is needed.

QUALIFICATIONS & EXPERIENCE:

• Must have experience with working with DME, Durable Medical Equipment claims.
• Must have experience working with insurance carriers to resolve or address denied or partially paid DME, Durable Medical Equipment claims.
• Demonstrate the ability to communicate, present and escalate issues to leadership at all levels of an organization, including executive level
• Experience delivering client-focused solutions to customer needs
• Strict adherence to company philosophy/mission statement/vision and goals
• Excellent interpersonal skills and communication with all levels of management and employees
• Critical thinker who can analyze situations and make decisions that support company goals and help to solve problems
• Strong verbal skills with a mix between soft and hard skills
• Strong motivational and listening skills
• Strong written communication skills
• Strong time management skills
• Able to multitask, prioritize, and manage time efficiently
• Able to analyze problems and strategize for better solutions
• 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.

PHYSICAL EFFORT:

Work time will be spent sitting approximately 95% of the time, standing and walking approximately 5% of work time. PC Keyboarding will constitute approximately 80% of work time.

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