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The ideal candidate must have hands-on experience using Brightree and understand Medicare, Medicaid, Medicare Advantage, and commercial insurance billing requirements for DME. This position requires someone who can identify and resolve billing problemsnot simply submit claims.
You will be responsible for ensuring claims are clean and complete, working claim rejections and denials, correcting documentation or authorization issues, following up on unpaid claims, posting payments, and helping the company collect all properly earned reimbursement.
Primary Responsibilities
- Submit accurate electronic and paper DME claims through Brightree
- Review claims for accuracy before submission
- Work clearinghouse and Brightree claim rejections promptly
- Investigate denied, underpaid, delayed, and unpaid claims
- Correct and resubmit claims when appropriate
- Prepare and submit reconsiderations and appeals with supporting documentation
- Follow up with Medicare, Medicaid, Medicare Advantage, and commercial insurance companies
- Review eligibility, benefits, deductibles, coinsurance, and payer coverage requirements
- Confirm that required prior authorizations are obtained and documented
- Verify that prescriptions, Standard Written Orders, medical records, Certificates of Medical Necessity, proof of delivery, and other supporting documents meet payer requirements
- Review HCPCS codes, modifiers, diagnosis codes, units, quantities, and dates of service for billing accuracy
- Understand rental, capped-rental, purchase, recurring-supply, and resupply billing
- Track authorizations, rental periods, continued-need documentation, and recurring claims
- Post insurance and patient payments, ERAs, EOBs, adjustments, refunds, and contractual write-offs accurately
- Reconcile payments and identify incorrect or missing reimbursements
- Work insurance and patient accounts-receivable aging reports
- Contact patients regarding deductibles, coinsurance, noncovered items, and outstanding balances professionally
- Establish and monitor patient payment arrangements when authorized
- Identify claims that require refunds, recoupment responses, or additional documentation
- Respond to payer requests, audits, ADRs, and medical-record requests within required deadlines
- Maintain detailed notes in Brightree regarding every billing action and payer communication
- Communicate with intake, documentation, respiratory, supply, and management teams to resolve billing barriers
- Track recurring denial patterns and recommend corrective action
- Maintain compliance with Medicare requirements, payer contracts, HIPAA, and company policies
- Assist with month-end reporting and other DME billing responsibilities as assigned
Equipment and Billing Knowledge Preferred
Experience billing one or more of the following is strongly preferred:
- CPAP, APAP, BiPAP, ASV, and related supplies
- Noninvasive ventilation
- Oxygen equipment and supplies
- Hospital beds and support surfaces
- Wheelchairs, walkers, and mobility equipment
- Diabetic shoes and orthotics
- Recurring and resupply orders
- Rental and capped-rental equipment
Required Qualifications
- Previous DME or HME billing experience
- Hands-on experience using Brightree
- Experience working claim rejections, denials, appeals, and accounts receivable
- Knowledge of Medicare DME billing requirements
- Familiarity with HCPCS codes, modifiers, diagnosis codes, authorizations, and medical-necessity documentation
- Ability to read and interpret EOBs and ERAs
- Strong attention to detail and organizational skills
- Ability to independently prioritize accounts and meet filing and appeal deadlines
- Clear written and verbal communication skills
- Ability to protect confidential information and comply with HIPAA requirements
- Reliable attendance and professional conduct
Preferred Qualifications
- At least two years of DME billing experience
- Experience with Michigan Medicaid and Michigan commercial insurance plans
- Experience with Medicare audits, ADRs, appeals, and recoupments
- Experience billing respiratory equipment and recurring supplies
- Strong knowledge of Brightree reporting and accounts-receivable worklists
- Billing or coding certification is helpful but not required
We are looking for someone who:
- Takes ownership of claims until they are paid or appropriately resolved
- Is persistent when following up with insurance companies
- Investigates the cause of a denial instead of repeatedly rebilling the same claim
- Keeps accurate and complete account notes
- Recognizes missing documentation before it causes a denial
- Communicates billing problems promptly to the appropriate department
- Works efficiently without sacrificing accuracy
- Treats patients and coworkers respectfully
Care One Medical is a leading provider of durable medical equipment, committed to improving the lives of patients. Our mission is to deliver high-quality, durable products that set industry standards and prioritize the well-being of our clients. Join our team and be part of an organization that values innovation, excellence, and compassionate care.