DME Billing, Audit & Claims Resolution Specialist

Med Supply US is looking for an experienced DME (Durable Medical Equipment) Billing, Audit & Claims Resolution Specialist to join our team.

We are looking for someone who is comfortable investigating complex billing issues, resolving denials, handling payer audits, and determining the appropriate course of action when claims do not process as expected.

Key Responsibilities:

• Review and respond to payer audits and medical record/documentation requests.
• Prepare audit responses and supporting documentation for submission.
• Investigate complex claim denials and determine the appropriate resolution.
• Research payer policies, billing requirements, and claim history when troubleshooting issues.
• Handle reconsiderations, appeals, re-openings, corrected claims, and other claim resolution processes.
• Identify billing discrepancies involving modifiers, diagnosis codes, ordering/referring providers, frequency, coordination of benefits, and other claim requirements.
• Review EOBs/ERAs and payer correspondence to identify the reason for non-payment.
• Communicate with insurance representatives, Medicare contractors, provider offices, and other parties when additional information is needed.
• Follow claims through resolution rather than simply submitting or resubmitting them.
• Maintain detailed documentation of research, calls, actions taken, and next steps.
• Assist with creating and improving internal billing processes and procedures based on recurring issues.

Preferred Qualifications:

• Strong experience in U.S. medical billing, AR, or claims resolution.
• Previous DME billing experience strongly preferred.
• Experience handling payer audits, ADRs, medical record requests, or similar reviews.
• Experience with Medicare billing, denials, re-openings, and appeals is highly preferred.
• Strong understanding of EOBs/ERAs, denial codes, claim corrections, and payer-specific billing requirements.
• Experience researching and interpreting payer policies.
• CGM billing experience is a plus.
• Familiarity with Medicare, Medicare Advantage, and commercial insurance plans.
• Experience with payer portals and electronic claim systems.
• Niko Health experience is a plus but not required.

The ideal candidate is someone who:

• Enjoys investigating and solving complicated billing problems.
• Can look at a denial and independently figure out what needs to happen next.
• Knows when a claim should be corrected, appealed, reopened, rebilled, escalated, or otherwise worked.
• Is comfortable researching situations where the answer is not immediately obvious.
• Has strong attention to detail and documentation skills.
• Can manage multiple unresolved cases and follow through until resolution.
• Communicates clearly and professionally with payers and provider offices.
• Is comfortable working independently and using good judgment

Work Setup: Remote.
Schedule: 9AM to 5PM EST.
Salary: Negotiable based on experience.

To Apply:

Please send your resume highlighting any experience with DME (Durable Medical Equipment), Medicare, payer audits, complex claims/denials, appeals, SOP creation, and team supervision or training.

Candidates with experience supervising, training, or serving as an escalation point for other medical billing staff are encouraged to apply.