Senior DME Operations & Revenue Integrity Specialist

Core Responsibilities

• Review physician orders and supporting medical records to validate medical necessity for straight, coude, and closed system catheters.
• Maintain audit-ready patient files in NikoHealth.
• Escalate documentation risks before shipment.
• Verify Medicare, MA, and commercial eligibility for claims.
• Confirm frequency limitations and coverage requirements for claims.
• Ensure claims are documentation-complete prior to submission.
• Analyze denial root causes and improve clean-claim rate.
• Support appeals and recoupments.
• Monitor AR trends and timely filing limits.
• Strengthen order workflows and build documentation checklists.
• Contribute to scalable team structure as volume grows.

30-60-90 Day Plan

• First 30 Days:
  • Foundation & Familiarization: Complete onboarding and training, review recent claims and denials, learn payer rules, shadow senior billing staff.
• Days 31-60:
  • Ownership & Efficiency: Independently manage daily claim submissions, reduce preventable denials, maintain clean-claim submission rate.
• Days 61-90:
  • Optimization & Leadership: Fully own billing and AR management, lead process improvement initiatives, mentor intake staff.

Requirements

• 3+ years Medicare Part B DME billing experience.
• Urology supply (catheter) billing or documentation experience.
• Hands-on denial correction and appeals experience.
• Experience using NikoHealth or similar DME system.
• Strong written and verbal English communication skills.
• Ability to think critically under compliance pressure.

Preferred

• Diabetes / CGM billing experience.
• ACHC or audit exposure.
• Prior workflow or team-building experience.