DME Billing Specialist
About The Position
The DME Billing Specialist is responsible for the accurate and timely submission, follow-up, and reconciliation of durable medical equipment (DME) claims. This role plays a critical part in ensuring clean claims, maximizing reimbursements, and maintaining compliance with payer and regulatory requirements. The ideal candidate has hands-on experience with Medicare, Medicaid MCOs, TRICARE, and commercial insurance plans. The Breastfeeding Shop is for mothers who need proper help, guidance, and accessories to help them with nursing their babies, The Breastfeeding Shop brings the best of all. We are a family-owned business and because we understand the joys and challenges of being a new mom, we have brought together a range of supplies for all mothers who choose to breastfeed or those who need access to a breast pump. www.thebreastfeedingshop.com The Breastfeeding Shop is an equal-opportunity employer.
Requirements
- hands-on experience with Medicare, Medicaid MCOs, TRICARE, and commercial insurance plans
Responsibilities
- Submit DME claims accurately and timely to Medicare, Medicaid, TRICARE, and commercial payers
- Ensure proper use of HCPCS codes , modifiers, units, and diagnosis codes
- Verify documentation requirements including prescriptions, CMNs, medical necessity, and proof of delivery (POD)
- Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs)
- Post payments, adjustments, and denials accurately
- Research, correct, and resubmit denied or rejected claims
- Manage payer follow-up for unpaid or underpaid claims
- Identify trends in denials and provide recommendations for process improvement
- Prepare and submit appeals with supporting documentation
- Monitor accounts receivable (AR) aging and prioritize follow-up
- Communicate with payers, clearinghouses, and internal teams to resolve issues
- Maintain accurate patient and payer records within the billing system
- Ensure compliance with CMS, Medicare, Medicaid, and payer-specific billing guidelines
- Stay up-to-date on changes in payer policies, fee schedules, and regulations
- Maintain HIPAA compliance and patient confidentiality at all times
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
