DME Wound Care Claims Denial Specialist

InfuSystem is a growing healthcare company that enables the continuity of patient care with integrated therapy services, biomedical services, and durable medical equipment serving all 50 states and Canada. InfuSystem offers Oncology, Pain Management, and Wound Care therapies, including Negative Pressure Wound Therapy. We deliver improved patient outcomes and high patient satisfaction.

As a leader in our field, our mission is to provide quality integrated therapy services to patients and medical practices, including a 24-hour clinical support hot line. Service is always our highest priority. Patients and clinicians in more than 2,150 sites of care trust InfuSystem as their full-service source for cost-effective integrated therapy services and durable medical equipment.

SUMMARY:

The DME Wound Care 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/non-payments, filing appeals for medical necessity, benefit coverage, etc. This position should have collections work experience in DME and wound care services. This position will have demonstrated proficiency in working a variety of payers and wound care services. Quality and productivity scores must be above average. This individual will also act as a knowledge source for the department for wound care 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
• Possess knowledge on billing guidelines and modifiers used for Advanced Wound Care and Negative Pressure Wound Therapy
• Have experience in submitting appeals for Advanced Wound Care and Negative Pressure Wound Therapy
• 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 five years related experience; or equivalent combination of education and experience • Five years of wound care billing/collections experience preferred • 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 managed-care plans • Ability to handle inquiries and respond via telephone or in writing • Ability to explain and resolve collections-related questions/issues to patients, sales representatives, and facilities • Proper use of ICD-10, CPT, and HCPCS codes • Ability to independently meet tight deadlines in a project-based 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:

At InfuSystem, we give our employees the tools to succeed both on and off the job. Our generous benefits package provides comprehensive coverage to help you protect your health and earning power and prepare for the future. In addition, we offer perks and programs that help you grow in your career and make InfuSystem a great place to work!
• Health plan options that include an employer contribution
• Health Savings Account (HSA)
• Healthcare and Dependent Care Flexible Spending Accounts (FSA)
• Dental and Vision premiums covered by InfuSystem
• Life Insurance, STD & LTD
• Paid Parental Leave
• Adoption and Fertility Assistance
• 401(k) with a specified Company Match
• Employee Stock Purchase Program
• Tuition Assistance
• Generous Paid Time Off plan
• Employee Assistance Program
• Competitive Pay
• Employee Referral Bonus
• Spot Bonus Program

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