DME Documentation Specialist

About the role

ACU-Serve delivers billing solutions to HME (Home Medical Equipment) providers, giving them the freedom to grow their business while collecting more, faster. ACU-Serve has helped HME businesses cut through the complexity of an ever-transitioning billing process while becoming a trusted partner for continued growth. Clients routinely show faster collections, higher revenue and dramatically reduced management and staffing problems. ACU-Serve incorporates HME workflow, Medicare, Medicaid and Private Payer knowledge, and billing and collections experts into a single service on an Internet-based technology platform. The result is faster payments, higher revenue collection rates, and less management and staffing headaches. Unlike traditional billing service models, ACU-Serve provides HME clients with a new level of control, flexibility, information access, and billing expertise. ACU-Serve functions as an integral part of the HME office staff, not a remote third party billing vendor.

Responsibilities

• Collects, reviews and requests medical documentation required to support medical necessity to submit for Prior Authorization.
• Submits and maintains prior authorizations and all certificates of medical necessity (CMN)
• Requests documentation to support medical necessity and ongoing need for various durable Medical equipment items including and not limited to oxygen and sleep therapy.
• Creates initial, revised and recertification certificates of medical necessity within various DME billing software systems.
• Reviews incoming CMN’s and medical records for accuracy.
• Reviews and completes stop hold reports to resolve and release held revenue to various payers.
• Knowledgeable of Medicare, Medicaid and other insurance companies’ rules regarding CMN’s, detailed written orders and prior authorizations.
• Ability to converse with clinicians and office staff to follow up on outstanding requests and to describe information required.

Qualifications

• Minimum of 1 year of experience in durable medical billing requirements; understanding Durable Medical Equipment intake processes including insurance verification, and Prior Authorization Requests.
• Experience working in DME billing platform – Brightree.
• Knowledge of requirements for Medicare, Medicaid, and Commercial payers as for what qualifies a patient for coverage of prescribed equipment.
• HS diploma/GED.
• Knowledge of documentation requirements for multiple HCPCs
• Strong computer skills including MS Word, Excel and strong keyboarding skills.
• Proven ability to use formal business language to communicate effectively in written form including spelling and punctuation.
• Strong attention to detail.
• Task oriented while performing in a fast-paced environment.
• Results-oriented self-starter with a can-do attitude, a sense of urgency and ability to complete tasks in a timely manner.
• Proven ability to review current processes and procedures and suggest process improvements or solutions.
• Able to work with others with diverse personalities.
• Good problem-solving skills including managing crisis situations calmly and professionally as well as the ability to maintain confidential patient, financial and company information, following HIPAA guidelines.