Medical Billing Specialist - DME

Overview of the Role

The Medical Billing Specialist - DME is responsible for managing key aspects of the revenue cycle process within Quest Health Solutions. While a third-party billing company handles initial billing functions, this role focuses on escalations, oversight, and specialized tasks to ensure accurate billing, effective denial management, and smooth coordination across departments. The RCM Specialist plays a vital role in maximizing revenue, supporting compliance, and enhancing overall operational efficiency.

Essential Duties and Responsibilities

Accounts Receivable (AR) & Billing

• Handling AR tasks, including research and resolution of outstanding balances.
• Conduct denials report reviews.
• Manage write-off approvals.
• Handle AR tasks related to denied or delayed claims.

Resupply Management Order Escalations

• Manage RCM intake and order escalations involving AR and billing-related issues.

Medicare Appeals Oversight

• Review Medicare appeals prepared by the billing company for accuracy.
• Provide guidance and direction to the billing company on appeal content and strategy when needed.

Customer Service

• Perform patient outreach to obtain updated information when required to resolve billing or order issues.
• Support patients in understanding billing-related inquiries and coordinate resolutions with internal teams.

Process Improvement

• Identify opportunities for process improvements within the revenue cycle to enhance efficiency, accuracy, and compliance.