DME Billing Specialist
The Breastfeeding ShopDME Billing Specialist
Job Summary
We are seeking a full-time, detail-oriented and organized DME Billing Specialist to join our team. The DME Billing Specialist is responsible for the accurate and timely submission, follow-up, and reconciliation of durable medical equipment (DME) claims. This role plays a critical part in ensuring clean claims, maximizing reimbursements, and maintaining compliance with payer and regulatory requirements. The ideal candidate has hands-on experience with Medicare, Medicaid MCOs, TRICARE, and commercial insurance plans.
Key Responsibilities
Ā Claims & Billing
- Submit DME claims accurately and timely to Medicare, Medicaid, TRICARE, and commercial payers
- Ensure proper use of HCPCS codes, modifiers, units, and diagnosis codes
- Verify documentation requirements including prescriptions, CMNs, medical necessity, and proof of delivery (POD)
- Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs)
- Post payments, adjustments, and denials accurately
Denials & Follow-Up
- Research, correct, and resubmit denied or rejected claims
- Manage payer follow-up for unpaid or underpaid claims
- Identify trends in denials and provide recommendations for process improvement
- Prepare and submit appeals with supporting documentation
Account Management
- Monitor accounts receivable (AR) aging and prioritize follow-up
- Communicate with payers, clearinghouses, and internal teams to resolve issues
- Maintain accurate patient and payer records within the billing system
Compliance & Accuracy
- Ensure compliance with CMS, Medicare, Medicaid, and payer-specific billing guidelines
- Stay up-to-date on changes in payer policies, fee schedules, and regulations
- Maintain HIPAA compliance and patient confidentiality at all times
Ā
The Breastfeeding Shop is for mothers who need help, guidance, with their pumps and accessories to help them with nursing their babies. We are a family-owned business and because we understand the joys and challenges of being a new mom, we have brought together a range of supplies for all mothers who choose to breastfeed or those who need access to a breast pump. www.thebreastfeedingshop.com
The Breastfeeding Shop is an equal-opportunity employer.
Job Type: Full-time
Benefits:
- Health insurance
- Paid time off