Durable Medical Equipment Billing Specialist
2 weeks ago
AS THE HOME MEDICAL EQUIPMENT BILLING SPECIALIST, you'll be under general supervision of the Billing Manager, the DME (DURABLE MEDICAL EQUIPMENT) Biller performs a variety of complex clerical and accounting functions for patient billing. Will be responsible for billing all payors for any DME item and rental items by verifying sales order information, obtaining authorization, if necessary, while following CMS Guidelines. Effectively manages all aspects of individual Revenue Cycle Management, including resolution of a variety of patient accounting problems. Issues and logs Certificates of Medical Necessity and follows up on unpaid claims by contacting any necessary entities. May handle cash items and accounts receivable posting. Must deliver empathetic and respectful customer service regarding our patients’ financial situation.
Requirements/Responsibilities
- Ability to effectively use Brightree
- Knowledge and proficient on various payor portals
- Create validation rules and coverage limitations alerts for CSRS to aid in sales order creation
- Check electronic inbound fax for CMN’s, EOB (Explanation of Benefits), progress notes, etc.
- Work daily individual Revenue Cycle Management types: billed claim follow-up, billing stops, CMN (Certificates of Medical Necessity) follow-up, denials, ERL follow-up, expired prior authorizations, timely filing, and unapplied payments.
- Knowledge of the Medicare Appeals Process using portal i.e., redeterminations, etc.
- Responsible for processing any updated information for claims to reprocess and ensure timely
- Update patient benefit, demographic and insurance information as needed.
- Maintain a strong knowledge of guidelines related to HIPAA, OIG Compliance, medical coding, and billing/reimbursement
- Resolve customer account discrepancies
- Monitor and maintain assigned accounts, customer calls, account adjustments, small balance write off, customer reconciliations and process patient and insurance refunds
- Reconcile customer disputes regarding balances due
- Assist Sales and other departments to resolve billing issues
- Ability to be discreet and maintain the security of patient or customer information
- Bill secondary claims electronically or by paper
- Log/send/recert/revise CMN’s.
- Bill all insurances, facilities, and non-insurance orders.
- Check daily work in progress for outstanding orders and tasks
- Complete timely billing audits/correspondence to insurance companies
- Create sales order if appropriate especially for oxygen contents and oxygen maintenance checks
- Communicate/obtain to personnel/supervisor/referral sources for non-compliance of documentation to ensure proper billing
- Knowledge of NAVINET, Promise, UPMC and all CHC (Community Health Choices) portals and its tools
- Knowledge of and verifying Same and Similar on Noridian JA portal
- Logging prior authorizations and create PAR (Prior Authorization Request) tasks for re-authorizations
- Maintain all price tables
- Fix front end denials before claims transmission to clearinghouse
- Bill for maintenance and contents of oxygen if possible
- Maintain and understand the patient pay portal and collection process in Collect Plus
- Notify billing manager of any problems noticed with repetitive denials/contracting denials, software issues, etc.
**Qualifications**:
- High school diploma (or equivalent) required
- 3 years’ experience in insurance billing
- Knowledge of electronic billing preferred
- High attention to detail and able to multitask
- Meets company minimum standard of Background Check
- Comply with Company Employee Manual
- Comply with company policies, procedures, and compliance.
- Comply with all company, state, and federal policies, laws, and regulations, including -HIPPA
- Maintain positive attitude and conduct yourself in a professional, ethical, and knowledgeable manner toward supervisor, patients, referral sources, co-workers, colleagues, subordinates, and members of the public: everyone
- Report to work regular, timely and gives advanced notice to supervisor for time off
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