Job Description:
• Reviews prescriptions, CMNs, chart notes, and signatures for completeness and accuracy.
• Validates documentation against Medicare, Medicaid, Medicare Advantage, and commercial payer requirements.
• Identifies and resolves documentation gaps prior to claim submission.
• Reviews insurance eligibility, coverage, authorizations, and benefit requirements.
• Confirms frequency limits, payer-specific rules, and authorization needs.
• Identifies and escalates payer coordination issues.
• Reviews HCPCS codes and modifier usage for DME product lines including Orthopedic Bracing, Wound Care, and CGM.
• Ensures billing accuracy aligned with payer policies and internal workflows.
• Escalates complex billing or coding issues appropriately.
• Maintains accurate order records and billing data in Brightree.
• Supports order tracking, billing preparation, and claim workflows.
• Ensures data consistency and integrity across systems.
• Communicates with payers to clarify documentation requirements or claim status.
• Supports claim follow-ups and documentation requests.
• Assists with appeals, denials, and resubmissions under senior billing guidance.
• Maintains internal tracking tools including error logs and on-hold reports.
• Ensures timely follow-up to minimize billing delays.
Qualifications:
• Has working knowledge of U.S. insurance billing processes.
• Experience supporting U.S. insurance billing (Medicare, Medicaid, Medicare Advantage, Commercial).
• Experience supporting multiple DME product lines (Orthopedic Bracing, Wound Care, CGM).
• Applies expertise in HCPCS coding, modifiers, CMNs, and medical necessity documentation.
• Experience collaborating with Intake, Confirmation, and Senior Billing teams.
• Exposure to appeals and denial management workflows.
• Maintains high accuracy, attention to detail, and documentation quality.
• Manages multiple tasks while meeting billing timelines.
• Reliable internet connection and secure remote workspace.
• Work independently in a remote setup.
• Works effectively with limited supervision.
• Clear and coherent both written and verbal communication skills in English, to effectively collaborate with internal teams and payer representatives.
Screening Criteria:
• Minimum of three (3) years of healthcare billing experience.
• Minimum of one (1) year of DME insurance billing with focus on orthopedic bracing and wound care experience.
• Experience using Brightree cloud-based software.
• Must have a stable employment history.
