Medical Denials & Billing Specialist

About the CompanyAptiva Medical is a growing DME provider making continuous glucose monitoring accessible to every patient who needs it. We partner with Abbott and Dexcom to serve Medicare and commercially insured patients nationwide. As we scale, we're investing in the people who protect our revenue and fix problems at the source.About the RoleYou'll spend most of your day in our denial queue " reading EOBs, working CARCs and payer rejections, filing appeals, calling payers, and chasing claims through payer portals until they're paid. You'll hit productivity and aging follow-up targets, and make sure every claim meets payer and Medicare documentation requirements before it goes back out.The difference at Aptiva is what happens next. The patterns you spot become process improvements we actually implement. You'll partner with our RCM Supervisor to trace denials back to their source " intake, documentation, authorizations, contracting, or a workflow gap " and coordinate with those teams to fix the root cause so the denial doesn't happen again.If you've ever looked at a denial queue and thought "the same five things keep showing up and nobody's fixing them," this is your role.ResponsibilitiesWork denied CGM claims; interpret CARCs, RARCs, and EOBs to find root causeIdentify denial patterns by payer and reason code, then recommend upstream fixesPartner with Intake, Sales, Documentation, and Billing to reduce repeat denialsServe as the in-house expert on Medicare CGM coverage, LCDs, and payer nuanceSupport appeals and escalations with a prevention mindsetHelp build the SOPs and best practices our growing RCM operation runs onQualifications3+ years in DME or CGM billing, denials, or reimbursementStrong knowledge of Medicare CGM coverage, documentation requirements, and applicable LCDsWorking knowledge of CGM HCPCS codes (A4239, E2103, A9276, A9277, A9278)Proven ability to interpret CARCs/RARCs and resolve, not just reprocess, denialsYou think in patterns, not in single claimsStrong written and verbal communicationPreferredDexcom or FreeStyle Libre experienceExposure to Waystar or HDMSComfort with Excel pivot tables for denial trend analysisSpecific examples of finding the root cause of a denial pattern and seeing the fix throughWhy AptivaReal influence. Your insights from the denial queue go directly to RCM leadership and shape how we fix problems upstreamA tight-knit onsite RCM team in Fort LauderdaleThe chance to shape infrastructure and SOPs as we scaleCompetitive compensation based on your experience, skills, and demonstrated impactAptiva Medical is an Equal Opportunity Employer. Reasonable accommodations available upon request.