Medical Billing Specialist

Role Overview

We are seeking a detail-oriented and experienced Medical Billing Specialist with a strong background in Durable Medical Equipment (DME) billing and front-end rejection resolution. This role is critical to ensuring seamless billing operations, regulatory compliance, and timely revenue collection.

Top Required Skills & Experience

• Front-End Rejections: Proven expertise in identifying, correcting, and resubmitting front-end rejected claims to minimize payment delays.
• DME Knowledge: Prior experience working specifically within Durable Medical Equipment (DME) billing, coding, and documentation requirements.

Core Responsibilities

• Billing & Claims Management
  • Responsibly manage the timely submission of both electronic and paper claims to third-party payers.
  • Troubleshoot, correct, and resubmit both front-end and back-end rejected claims efficiently.
  • Confirm all sales orders within the billing system, ensuring that critical data points (e.g., proof of delivery, signed prescriptions, signed acknowledgement forms) are secured prior to claim submission.
  • Follow up on missing sales orders and systematically reconcile billing questions until payment status is finalized.
  • Ensure all received cash and payments are accurately posted to the correct accounts in a timely manner.
• Insurance Verification & Patient Accounts
  • Coordinate the comprehensive insurance verification process and clearly communicate co-pay and financial responsibilities to patients.
  • Manage the collection of co-pays, securing credit card or payment processing information securely and entering it accurately into the billing system.
  • Accurately input new patient and referral demographics, proactively contacting referral sources, customers, or patients to retrieve missing documentation.
• Compliance & Industry Knowledge
  • Ensure all phases of patient data processing strictly adhere to HIPAA, PHI regulatory guidelines, and company policies.
  • Promptly escalate any compliance or operational issues directly to leadership.
  • Utilize industry resources to stay current on regulatory guidelines and reimbursement methodologies to ensure accurate billing practices.
• Additional Operations
  • Perform other duties and projects as assigned by management, including providing occasional customer service support by processing, resolving, and logging customer inquiries.

Qualifications

• High School Diploma or equivalent required (Billing/Coding certification preferred).
• Demonstrated experience handling front-end medical billing rejections.
• Solid baseline of Durable Medical Equipment (DME) billing regulations and paperwork.
• High level of proficiency with electronic medical billing software and data entry.
• Exceptional attention to detail and strong communication skills.