What are the responsibilities and job description for the Medical Denials & Revenue Integrity Specialist position at Aptiva Medical?
About the Company
Aptiva Medical is a growing DME provider making continuous glucose monitoring accessible to every patient who needs it. We partner with Abbott and Dexcom to serve Medicare and commercially insured patients nationwide. As we scale, we're investing in the people who protect our revenue and fix problems at the source.
About the Role
You'll own denied CGM claims across Medicare and Commercial payers, but the real work isn't reworking them. It's finding the patterns, tracing them back to intake, documentation, or workflow gaps, and partnering with our RCM Supervisor to fix the root cause so the denial doesn't happen again.
If you've ever looked at a denial queue and thought "the same five things keep showing up and nobody's fixing them," this is your role.
Responsibilities
- Analyze denied CGM claims; interpret CARCs, RARCs, and EOBs to find root cause
- Identify denial patterns by payer and reason code, then recommend upstream fixes
- Partner with Intake, Sales, Documentation, and Billing to reduce repeat denials
- Serve as the in-house expert on Medicare CGM coverage, LCDs, and payer nuance
- Support appeals and escalations with a prevention mindset
- Help build the SOPs and best practices our growing RCM operation runs on
Qualifications
- 3 years in DME or CGM billing, denials, or reimbursement
- Strong knowledge of Medicare CGM coverage, documentation requirements, and applicable LCDs
- Working knowledge of CGM HCPCS codes (A4239, E2103, A9276, A9277, A9278)
- Proven ability to interpret CARCs/RARCs and resolve, not just reprocess, denials
- Analytical mindset; you spot trends and think systemically
- Strong written and verbal communication
Preferred
- Dexcom or FreeStyle Libre experience
- Exposure to Waystar or HDMS
- Comfort with pivot tables or Power BI
- A track record of measurably reducing denial rates
Why Aptiva
- Real influence. Leadership wants your recommendations, not just your output
- A tight-knit onsite RCM team in Fort Lauderdale
- The chance to shape infrastructure and SOPs as we scale
- Competitive compensation based on your experience, skills, and demonstrated impact
Aptiva Medical is an Equal Opportunity Employer. Reasonable accommodations available upon request.