DME Claims Specialist

Job Requirements

PRIMARY ACCOUNTABILITIES

1. Process medical equipment claims daily reviewing for batch failures, rejections, reviews

reports for errors, adjust modfiers as needed, and troubleshoot claim information prior to

transmitting.

2. Perform Quality Assurance chart reviews related to billing, customer service, signatures,

orders, co-pay collections, reimbursement trends, timely filing, etc. to ensure federal

guidelines, AHCA, and Joint Commission requirements are met.

3. Research patient accounts, resolving claim issues associated insurance and benefits

verification. Identifying five year replacement of equipment and converting equipment to

purchase.

4. Identify trends in failed claims, make corrections, and communicate to management. Use

information from failed claims and chart reviews to assist in training associates on payer

guidelines and requirements for dispensing medical equipment and billing.

5. Post payments, adjustments, and credits daily using general knowledge of third-party claims

reimbursement practices. Process refunds for submission.

6. Understand, interpret, research, and appropriately handle basic insurance correspondences.

7. Analyze and resolve complex payer issues, payment trends and communicate to leadership

promptly and accurately.

8. Apply Federal/State/Industry standard guidelines to resolve claim issues as approved by

department leadership.

9. Identify process workflows, trends, and recommend improvements and share ideas that

positively impact financial outcomes.

10. Participate in month end and year end report processes. Communicate reports to Finance

department.

11.Attend meetings and webinars related to industry updates and report/train department staff

on what is learned. Participate in projects analyzing department data to assist in education

and process improvement.

12. Work closely with Leadership and DME Buyer researching Lost, Stolen or Damaged items,

reaching out to responsible parties to locate equipment.

Work Experience

MINIMUM QUALIFICATIONS

• Education: High School/GED
• Licensure: None required
• Certification: Successful completion of a Level II background screening
• Work Experience:
• One year experience in health care billing or related
• One year experience in a DME role.
• Work Experience in lieu of Education: None
• Knowledge/Skills/Abilities:
• Knowledge of claims review and analysis.
• Excellent verbal and written communication skills.
• General knowledge of coding (ICD-9, ICD-10, CPT and HCPCS).
• General knowledge of medical terminology.
• Superior knowledge in all business office applications and systems including

Microsoft Office.

• Able to respond positively to stressful situations and changes.
• Demonstrated effective communication and problem-solving skills.
• Positively and professionally, interact with customers and associates.
• Demonstrated ability to work effectively as a team member.
• Self-directed and capable of working without direct supervision.

PREFERRED QUALIFICATIONS

• Education: Bachelor's degree in related field
• Licensure: No additional
• Certification: No additional
• Work Experience: 3 years progressive experience in health care billing
• Knowledge/Skills/Abilities: No additional

PHYSICAL REQUIREMENTS

• Majority of time involves sitting or standing; occasional walking, bending, stooping
• Long periods of computer time or at workstation
• Light work that may include lifting or moving objects up to 20 pounds with or without

assistance.

• May be exposed to inside environments with varied temperatures, air quality, lighting

and/or low to moderate noise

• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks
• Workspace may vary from open to confined; on site
• May require travel to various facilities within and beyond county perimeter; may require

use of personal vehicle.

ABOUT HEALTH FIRST

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.