DME Billing Specialist

Guardian Home Healthcare•Raleigh, NC

About The Position

The DME Billing Specialist manages billing for Durable Medical Equipment (DME), including timely claim submission, payment processing, denial resolution, and compliance with payer guidelines. The role requires knowledge of insurance billing and Medicare and Medicaid regulations, along with strong customer service skills. The specialist verifies insurance eligibility, benefits, and authorization requirements; reviews physician orders and supporting documentation; follows up on claims; resolves discrepancies and appeals; posts payments and adjustments; and maintains accurate account records. The role also supports accounts receivable and collections, communicates with insurers, patients, and healthcare providers, and prepares reports on billing performance and reimbursement trends.

Requirements

High school diploma or equivalent.
At least 1–2 years of medical billing or DME billing experience.
Knowledge of Medicare, Medicaid, and commercial insurance billing procedures.
Familiarity with HCPCS, ICD-10, and CPT coding.
Proficiency in billing software, Microsoft Office Suite, and electronic medical records (EMR/EHR) systems.
Strong analytical, organizational, and problem-solving skills.
Excellent verbal and written communication skills.
Ability to manage multiple priorities while meeting deadlines.
Attention to detail and accuracy.
Knowledge of insurance verification and authorization management, claims processing and denial resolution, time management and organization, customer service, data entry and record maintenance, and healthcare regulations and compliance standards.

Nice To Haves

Associate degree in Healthcare Administration, Medical Billing, or a related field.
Certified Professional Biller (CPB) or related certification.
Experience working in a DME supplier, home medical equipment company, or healthcare setting.

Responsibilities

Process and submit DME claims accurately and promptly.
Verify patient insurance eligibility, benefits, and authorization requirements.
Review physician orders and supporting documentation for billing compliance.
Monitor claim status and follow up on unpaid, denied, or rejected claims.
Resolve billing discrepancies and initiate appeals when necessary.
Post payments and adjustments and reconcile patient accounts.
Communicate with insurance carriers, patients, and healthcare providers about billing matters.
Maintain accurate records of billing activities and account status.
Ensure compliance with Medicare, Medicaid, commercial insurance, and company policies.
Assist with accounts receivable management and collections activities.
Prepare and maintain reports related to billing performance and reimbursement trends.