Medical Billing & Denial Specialist (DME)

Job Description

Job Description

Description:

HIRING REMOTE EXPERIENCED BILLERS IN THE FOLLOWING STATES: AL,FL, GA, IN, LA, MS, NC, SC, TN, TX, VA, & WV

***** MI RESIDENTS WITHIN 40 MILES OF 48393 WILL BE HYBRID

Are you an Experienced Medical Biller LOOKING FOR GROWNING COMPANY WITH ROOM FOR ADVANCEMENT?

APPY NOW!

- Full Benefits after 30 Days!! PTO after 90 Days! and MORE!!!!

The Medical Billing & Denial Specialist is responsible for analyzing, appealing, and resolving insurance claim denials for Durable Medical Equipment (DME). Utilizing the Universal Software Solutions HDMS platform, this role requires deep regulatory knowledge to craft effective, logic-based written appeals that maximize reimbursement. The ideal candidate takes an analytical approach, identifying payer denial trends to proactively prevent recurring billing errors.

Essential Responsibilities & Tasks

Denial Management & System Workflows

• HDMS Queue Navigation: Utilize Universal Software Solutions HDMS to monitor, prioritize, and process daily denial workflows and collections worksheets.
• Audit & Correct: Review denied claims within HDMS for coding accuracy and execute required corrections before submission.
• Appeal Excellence: Draft well-researched, logical written appeals based on strict contract, coding, and medical record reviews.
• Payer Navigation: Resolve claim bottlenecks across commercial, Medicare, Medicaid, and Medicare Advantage plans.
• No-Response Claims: Investigate outstanding claims with zero payer response to verify receipt and accelerate processing.

Root-Cause Analysis & Strategy

• Trend Identification: Detect systemic payer denial patterns within HDMS data streams and communicate findings to management to prevent future errors.
• Policy Tracking: Monitor regulatory changes, Medicare Local Coverage Determinations (LCDs), and individual payer policy shifts.
• Team Knowledge Share: Inform internal team members of updated payer guidelines and assist with peer education as needed

Operational Support

• Internal Collaboration: Partner with coders, billers, and management to resolve cross-departmental coding disputes.
• Quality Assurance: Achieve designated organizational goals regarding error-free transactions, compliance metrics, and aging AR timelines.
• Escalation Support: Act as the primary point of contact for complex, unresolved billing and denial challenges.

Position Type & Schedule

• Status: Full-time (40 hours per week).
• Schedule: Monday through Friday, Day Shift.
• Flexibility: Occasional evening and weekend work may be required based on operational demands.

Minimum Qualifications

• Experience: 3+ years of dedicated DME billing, coding, and insurance collections experience.
• Software Proficiency: 1+ years of hands-on experience navigating Universal Software Solutions HDMS (or similar broad-scale DME enterprise billing software).
• Payer Knowledge: Proven background managing Medicare, Medicaid, and commercial claims.
• Technical Skills: Experience with Electronic Data Interchange (EDI) transmissions and advanced Excel skills.
• Education: High school diploma or GED equivalent.

Preferred Qualifications

• Advanced HDMS Skills: Familiarity with the HDMS workspace, StowPoint document management, or automated workflow tools.
• DMEPOS Expertise: Deep familiarity with DMEPOS fee scheduling files, laws, and compliance regulations.
• Regional Guidelines: Strong working knowledge of Multi-State Medicare Local Coverage Determinations (LCDs).
• Portal Proficiency: Hands-on experience navigating CMS and EPS provider portals.

Technical Infrastructure (BYOD)

• Equipment: This position requires a Bring Your Own Device (BYOD) setup. Equipment is not provided.
• Hardware: You must own and maintain a reliable computer capable of securely running healthcare software.

Other Duties

All other duties as assigned by management.