DME Claims Denial Specialist

InfuSystem is a growing healthcare service provider specializing in infusion pumps and related products and services for patients in hospitals clinics ambulatory surgery centers and other major service centers. We provide direct payer rentals pump and consumable sales and biomedical services and repair serving all 50 states and Canada. Headquartered in Rochester Hills Michigan we have Centers of Excellence in Kansas California Massachusetts Texas and Ontario Canada.

As a leader in our field our mission is to provide quality infusion services to patientsand medical practices including a 24hour clinical support hotline. Our team effort provides product management and clinical support to enhance the lives of ourpatients and the communities we serve. Service is always our highest priority; keeping the patients health & safety at the center of everything we do.

SUMMARY:

The DME Claims Denial Specialist is responsible for the management of activities relative to third party payer collections. This includes but is not limited to performing accounts receivable management following up on denials/nonpayments filing appeals for medical necessity benefit coverage etc. This position should have collections work experience in DME and other healthcarerelated services.

IN THIS ROLE THE IDEAL CANDIDATE WILL:

• Monitor accounts receivable agings to ensure timely resolution of claims
• Ability to identify and report any trends causing future potential denials
• Ensure payment accuracy
• Must be able to interpret payer explanation of benefits (EOBs)
• Review payer denials analyze accounts and determine the next appropriate steps to achieve payment success
  • This will include payer portal review and phone calls to payers. Successful candidates will have the ability to clearly and concisely communicate the issues that they are seeing and request payer representatives to assist with resolution.
• Conduct insurance reverification as needed through various eligibility tools
• Research write and submit appeals as appropriate
• Process third party payer correspondence refunds and adjustments
• Accurately and thoroughly document the pertinent collections activities in appropriate systems
• Respond to all patient inquiries timely
• Remain up to date on payer medical policy notices and changes
• Share information and ideas for process improvements with team
• Comply with all work instructions policies and behavioral expectations

QUALITY AND QUANTITY OF WORK

Team members will be responsible for hitting regular productivity targets with a high level of quality. Quality audits will be performed on a regular basis and feedback and education will be provided to the team member to help support growth and development.

SUPERVISORY RESPONSIBILITIES:

This job has no supervisory responsibilities.

THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS:

• Associate Degree or equivalent preferred; minimum two years related experience; or equivalent combination of education and experience
• Organizational skills
• Good troubleshooting skills
• Strong attention to detail
• Proficient with Word Excel Outlook
• Operate Express/HDMS/Waystar proficiently
• Understanding of insurance guidelines including Medicare Medicaid Workers Compensation and all Commercial managedcare plans
• Ability to handle inquiries and respond via telephone or in writing
• Ability to explain and resolve collectionsrelated questions/issues to patients sales representatives and facilities
• Proper use of ICD10 CPT and HCPCS codes
• Ability to independently meet tight deadlines in a projectbased atmosphere

PERSONAL AND PROFESSIONAL ATTRIBUTES:

Required to understand and have a commitment to the philosophy mission values and vision of the business and will be required to demonstrate these values with his/her daily actions. The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:

• Strong work ethic
• Sound judgment
• Proven written and verbal communication skills
• Natural curiosity to pursue issues and increase expertise
• Passionate about InfuSystem and serving customers and patients
• Strives to make an impact on improving our business processes and results
• Exemplary honesty and integrity
• Ability to collaborate effectively and work selflessly as part of a team

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

COMPREHENSIVE BENEFIT PACKAGE TO INCLUDE:

• Health Dental Vision
• Life Insurance STD & LTD
• 401(k) with a specified Company Match
• Employee Stock Purchase Program
• Tuition Assistance
• Generous Paid Time Off plan
• Paid Parental Leave
• Employee Assistance Program
• Competitive Pay
• Direct Deposit
• Employee Referral Bonus

Required Experience:

Unclear Seniority