About Us:
ProSUM Health is a dedicated Durable Medical Equipment (DME) provider focused on delivering quality care to patients in need. We are committed to enhancing patient care with a professional, compassionate, and efficient approach. We are currently seeking a highly motivated and experienced DME Medical Biller to join our team.
Position Overview:
As a DME Medical Biller at ProSUM Health, you will play an essential role in the revenue cycle process, ensuring timely and accurate billing for DME products and services. You will work directly with patients, insurance companies, and healthcare providers to manage billing tasks such as preauthorizations, posting EOBs, working on denials, and sending out patient invoices. Your expertise will help ensure our patients receive the care they need while maintaining efficient operations within the company.
Key Responsibilities:
- Claim Processing: Process and submit medical claims to insurance companies and government programs, ensuring correct coding with HCPCS and ICD-10 codes.
- Record Review & Accuracy: Review patient records for accuracy and completeness, ensuring proper coding using ICD-10, ICD-9, and DRG systems.
- Preauthorization Management: Request and track preauthorizations for DME services and equipment with insurance providers.
- EOB Posting: Post Explanation of Benefits (EOBs) to patient accounts and follow up with insurance carriers as needed.
- Denial Management: Review and resolve claim denials, working with insurance companies to appeal and correct issues.
- Patient Invoicing: Generate and send accurate patient invoices for DME services and products.
- Billing Compliance: Ensure all billing practices comply with CMS and insurance company requirements.
- Collection Management: Follow up on unpaid claims and manage the medical collection process effectively.
- Documentation: Maintain detailed records of billing activities and patient interactions.
- Collaboration: Communicate with healthcare providers to clarify any discrepancies in patient information or billing issues and collaborate with other departments to ensure seamless operations.
- Regulatory Updates: Stay updated on changes in medical billing regulations and coding practices.
Qualifications:
- 2+ years of experience in DME billing or a similar role in a healthcare setting.
- Deep understanding of HCPCS codes, ICD-10, ICD-9, and DRG systems for accurate billing and coding.
- Familiarity with insurance preauthorizations, EOBs, and denial management.
- Strong knowledge of Medicare and private insurance billing processes.
- Proficiency in medical terminology and understanding of medical office operations.
- Experience with electronic health record (EHR) systems and billing software.
- Strong attention to detail, analytical skills, and the ability to review medical records accurately.
- Excellent communication skills for interacting with patients, providers, and insurance representatives.
- Ability to work independently and as part of a team in a fast-paced environment.
Preferred Skills:
- Previous experience in medical billing or coding is preferred but not required.
- Knowledge of DME reimbursement policies and procedures.
- Familiarity with HIPAA regulations and maintaining patient confidentiality.
Additional Information:
- Equal opportunity employer committed to a diverse environment
- This description is a general outline of duties, not a comprehensive list of responsibilities
Job Type: Full-time
Pay: $25.00 - $30.00 per hour
Expected hours: 40 per week
Benefits:
- Paid time off
Schedule:
- 8 hour shift
- Monday to Friday
Work Location: In person
