RCM Specialist (DME)

Job Summary
We are seeking a detail-oriented and experienced Durable Medical Equipment (DME) Billing Specialist to join our team. The ideal candidate will be responsible for preparing, reviewing, and submitting DME claims to Medicare, Medicaid, and private insurance companies. This role requires a strong understanding of billing regulations, coding standards, and insurance policies to ensure accurate and timely reimbursement. The DME Billing Specialist will play a critical role in managing the entire claims process, resolving discrepancies, and maintaining compliance with healthcare regulations.

Key Responsibilities
Prepare, review, and submit Durable Medical Equipment (DME) claims accurately to Medicare, Medicaid, and private insurers. Ensure all claims are complete and comply with current billing regulations to minimize denials and delays. Apply the correct HCPCS, CPT, and ICD-10 codes specific to DME services and equipment, maintaining up-to-date knowledge of coding requirements.

Stay informed about changes in insurance policies and billing guidelines to prevent claim denials and optimize reimbursement. Track the status of submitted claims and proactively follow up on unpaid or denied claims to ensure timely resolution. Identify billing errors or discrepancies, investigate root causes, and resubmit corrected claims when necessary.

Communicate effectively with insurance companies, patients, and healthcare providers to resolve billing issues and clarify claim details. Provide patients with accurate billing information and assist with inquiries related to payments and insurance coverage. Monitor incoming payments to verify correct reimbursement amounts and reconcile accounts accordingly.

Accurately post payments and adjustments in the billing system, maintaining detailed records of all claims, payments, and related documentation. Generate regular reports to track billing performance, identify trends, and highlight areas for process improvement. Ensure strict adherence to HIPAA compliance and maintain patient data confidentiality at all times.

Required Qualifications
Strong knowledge of Durable Medical Equipment billing procedures, insurance guidelines, and claim processing workflows. Proficiency in applying HCPCS, CPT, and ICD-10 codes relevant to DME services and equipment. Experience working with medical billing software and electronic claims submission platforms.

Demonstrated ability to manage multiple claims efficiently while meeting deadlines and maintaining accuracy. Excellent analytical and problem-solving skills to identify and resolve billing discrepancies. Strong communication skills to interact professionally with insurance representatives, healthcare providers, and patients.

Thorough understanding of HIPAA regulations and commitment to protecting patient privacy and sensitive information.

Preferred Qualifications and Benefits
While not explicitly stated, candidates with prior experience in a healthcare billing environment or familiarity with Medicare and Medicaid billing processes will be highly valued. Opportunities for professional development and training in medical billing and coding may be available.

This role offers the chance to contribute to a vital function within healthcare administration, ensuring providers receive timely reimbursement and patients receive clear billing support. Join our team and leverage your expertise to enhance billing accuracy and operational efficiency.