02/08/2023
The Durable Medical Equipment Biller and Office manager will oversee,
1. Day-to-day process management of the billing, AR and payment posting.
2. They will use their knowledge and expertise to ensure the efficiency of inventory, customer support and billing processes and create and implement changes or improvements when necessary to ensure profitability and control assets.
3. Good skill level in computer software (Microsoft Office suite - Word, Excel, Outlook) and telephone technologies
4. Experience with EHR/EMR and Integra required (do not apply if do not meet this criteria)
5. Experience with Eligibility and how to read Explanation of Benefits (EOBs)
6. Knowledge of MEDICAL BILLING is REQUIRED!
7. Strong organizational skills and able to handle multiple functions seamlessly with excellent attention to detail
8. Must know all operational aspects and guidelines for DME, ability to lead the office and work under pressure
9. Oversees billing processes to ensure needs are met to work efficiently and effectively
10. Resolves complaints or issues in a professional manner
11. Will be responsible for billing all payors for any DME item and rental items by verifying sales order information, obtaining authorization, if necessary, while following CMS Guidelines
12. Effectively manages all aspects of individual Revenue Cycle Management, including resolution of a variety of patient accounting problems
13. Issues and logs Certificates of Medical Necessity and follows up on unpaid claims by contacting any necessary entities
14. May handle cash items and accounts receivable posting
15. Must deliver empathetic and respectful customer service regarding our patients’ financial situation
16. Confirm all sales orders for various rental and purchase items of DME by verifying proof of delivery, ordering doctor, diagnosis, verify insurance and coinsurance percentages, address all coverage limitations and validation rules
17. Apply patient payments and upload tracking if applicable
18. Review prescriptions, progress notes or HSTs and edit any pending or expired CMNs (Certificates of Medical Necessity) to send to physician, mark sales order complete
19. Create validation rules and coverage limitations alerts for CSRS to aid in sales order creation
20. Check electronic inbound fax for CMN’s, EOB (Explanation of Benefits), progress notes, etc
21. Work daily individual Revenue Cycle Management types: billed claim follow-up, billing stops, CMN (Certificates of Medical Necessity) follow-up, denials, ERL follow-up, expired prior authorizations, timely filing, and unapplied payments
22. Knowledge of the Medicare Appeals Process using portal i.e., redeterminations, etc
23. Maintain a strong knowledge of guidelines related to HIPAA, OIG Compliance, medical coding, and billing/reimbursement
24. Bill secondary claims electronically or by paper
25. Check daily work in progress for outstanding orders and tasks
26. Complete timely billing audits/correspondence to insurance companies
27. Communicate/obtain to personnel/supervisor/referral sources for non-compliance of documentation to ensure proper billing
28. Logging prior authorizations and create PAR (Prior Authorization
