DME Billing Specialist

Full-time - Entry Level

Peachtree Corners, GA

Merchant Wholesalers, Durable Goods

About the position

The Quality Assurance Specialist at Brightree plays a crucial role in ensuring the success of the Billing Center by conducting quality assurance activities. This position involves analyzing trends, implementing quality measures, and educating partners and clients to optimize claim processing and improve revenue cycle practices.

Responsibilities

• Learn multiple insurance guidelines and specific durable medical equipment requirements for Medicare, National Commercial, and Medicaid plans.
• Ensure quality confirmation for optimal claim processing and analyze sales order trending issues (KPI).
• Immediately escalate quality-related issues.
• Analyze medical documentation to qualify patients for equipment, supplies, or testing as per provider specifications.
• Conduct random audits on all transactions processed by internal teams and communicate and track trended results.
• Escalate quality-related issues, errors, trainings, and support to Internal & External Teams in a timely manner.
• Create and modify Standard Operating Procedures (SOP) & Workflow systems for specific payor and/or client rules.
• Implement and adhere to policies, procedures, and systems within Brightree systems.
• Ensure accuracy to optimize reimbursement while adhering to company policies and maintaining compliance.
• Ensure adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals to improve Revenue Cycle practices and increase revenue.
• Complete tasks in a timely manner and perform other assigned responsibilities.

Requirements

• High School degree required; college coursework is a plus.
• Knowledge of durable medical equipment and insurance billing.
• Strong communication skills and ability to multi-task while maintaining task completion and timely deadlines.
• Proficient in Microsoft Office products including Outlook, Excel, Word, and PowerPoint.
• Capable user of remote collaboration tools: Zoom, Go-To Meeting, Microsoft Teams, and SharePoint.
• Equivalent combination of education and experience will be considered.

Nice-to-haves

• Knowledge of Power Mobility, Sleep Studies, and CGMs.
• Familiarity with Brightree software.

Benefits

• Comprehensive medical, vision, dental, and life insurance.
• AD&D, short-term and long-term disability insurance.
• Sleep care management.
• Health Savings Account (HSA).
• Flexible Spending Account (FSA).
• Commuter benefits.
• 401(k).
• Employee Stock Purchase Plan (ESPP).
• Employee Assistance Program (EAP).
• Tuition assistance.
• Fifteen days Paid Time Off (PTO) in the first year.
• Eleven paid holidays plus three floating days.
• Fourteen weeks of primary caregiver leave or two weeks of secondary caregiver leave when welcoming new family members.