Prepare, submit, and track DME claims to Medicare, Medicaid, and commercial payers.
Verify coverage, benefits, and authorization requirements to ensure clean claim submission.
Review clinical documentation, prescriptions, and CMNs/SMNs for accuracy and completeness.
Work claim rejections and denials, and submit timely appeals with appropriate documentation.
Prepare and respond to insurance audits, recoupments, and payer requests.
Analyze denial codes, identify root causes, and document trends for internal review.
Ensure compliance with payer guidelines, LCDs, and audit standards.
Post payments, reconcile accounts, and resolve discrepancies in a timely manner.
Communicate professionally with providers, referral partners, and patients as needed.
Maintain accurate billing records while consistently meeting productivity and quality benchmarks.
Monitor aging reports and support efforts to reduce DSO.
Review stop/hold reports and ensure follow-up is completed.
Maintain and monitor payer fee schedules.
Support month-end processes and internal reporting requirements.
Additional responsibilities as needed to support the revenue cycle and billing team.
