Job Description
Job DescriptionDescription:
POSITION SUMMARY
The Billing Specialist is responsible for managing and processing insurance claims for Durable Medical Equipment (DME) services. This role requires a strong understanding of healthcare billing processes, insurance verification, claim submission, and resolving discrepancies related to billing. The Billing Specialist will work closely with customers, insurance companies, and healthcare providers to ensure timely and accurate reimbursement for DME products and services.
Requirements:
ESSENTIAL DUTIES AND JOB RESPONSIBILITES
The essential functions include, but are not limited to the following areas:
Key Responsibilities:
- Claim Management:
- Process and submit insurance claims for DME services to various insurance carriers (e.g., Medicare, Medicaid, private insurance).
- Ensure compliance with payer policies, coding standards, and billing regulations.
- Follow up on unpaid or rejected claims and re-submit as necessary.
- Monitor claim status to identify and resolve delays in payment.
- Insurance Verification:
- Verify patient insurance coverage for DME services before processing orders.
- Obtain pre-authorization or prior approval for services when required by insurance carriers.
- Communicate with customers and providers regarding coverage and potential out-of-pocket costs.
- Patient Billing:
- Generate and issue invoices to patients for services not covered by insurance.
- Manage patient payment plans and maintain accurate records of balances.
- Respond to patient inquiries regarding their bills and provide clarification on charges.
- Documentation and Coding:
- Review and accurately code DME products and services using appropriate CPT, HCPCS, and ICD-10 codes.
- Ensure that all necessary documentation is submitted with claims, including prescriptions, certificates of medical necessity (CMNs), and supporting medical records.
- Reporting and Reconciliation:
- Track billing performance metrics, such as claim acceptance rates, days in accounts receivable (A/R), and outstanding balances.
- Reconcile payments with patient accounts and insurance records.
- Collaborate with the finance department to ensure proper revenue recognition and report discrepancies.
- Compliance and Audits:
- Stay up-to-date on current DME billing regulations, including Medicare and Medicaid policies.
- Assist with internal and external audits by providing billing records and supporting documentation.
- Ensure adherence to HIPAA guidelines and protect patient information.
EDUCATION & EXPERIENCE REQUIREMENTS
- High School diploma or equivalent
- Associate’s or Bachelor’s degree in Accounting or related field preferred
- DME billing experience preferred
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodation may be made to enable individuals with disabilities to perform the functions. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodation may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to work inside a clean, well-lit office setting. While performing the duties of this position, the incumbent is regularly required to talk or hear. The employee frequently is required to use hands or finger, handle, or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus. The noise level in the work environment is usually moderate. The employee may be exposed to some hazards such as radiation, bodily fluids that may contain disease.