DME Medical Billing

3 weeks ago

Akron, United States ACU-Serve Corp. Full time
ACU-Serve delivers billing solutions to HME (Home Medical Equipment) providers, giving them the freedom to grow their business while collecting more, faster. ACU-Serve has helped HME businesses cut through the complexity of an ever-transitioning billing process while becoming a trusted partner for continued growth. Clients routinely show faster collections, higher revenue and dramatically reduced management and staffing problems. ACU-Serve incorporates HME workflow, Medicare, Medicaid and Private Payer knowledge, and billing and collections experts into a single service on an Internet-based technology platform. The result is faster payments, higher revenue collection rates, and less management and staffing headaches. Unlike traditional billing service models, ACU-Serve provides HME clients with a new level of control, flexibility, information access, and billing expertise. ACU-Serve functions as an integral part of the HME office staff, not a remote third party billing vendor.

Position Summary

The DME Billing and Claims 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
  • 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.

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.

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