DME Denials and Appeals Specialist

 InfuSystem is a leading national health care service provider, facilitating outpatient care for durable medical equipment manufacturers and health care providers by delivering ambulatory pumps and supplies, along with related clinical, biomedical and billing services, to practices and patients nationwide. With a comprehensive suite of services, InfuSystem improves clinician access to quality medical equipment and promotes patient wellness and safety while reducing the overall cost of infusion care.

InfuSystem offers Oncology, Pain Management and Wound Care therapies, including Negative Pressure Wound Therapy. The company’s Durable Medical Equipment (DME) Services are composed of direct payer rentals, pump and consumable sales, and biomedical services and repair, including on-site and depot services. InfuSystem provides the sale, rental, lease and associated supplies, including infusion pumps, nerve blocks for acute pain, nerve block catheters, postoperative pain pumps, central venous catheters, IV pumps, pole-mounted pumps, syringe pumps, enteral pumps, Huber needles, clean room supplies, IV extension tubing, pump tubing, ambulatory pumps, replacement pumps, disposable products, central venous access devices, closed system transfer devices, negative pressure wound therapy vacs, wound vac, and chemotherapy and oncology infusion pumps. Biomedical services include both on-site and depot preventive maintenance, repair and warranty services, ranging from equipment inspections to extensive repairs, including compression device systems, defibrillators, EKG machines, electrosurgical units, external pacemakers, humidifiers, infusion pumps, LCDs, light sources, modules, patient monitors, printers, pulse oximeters, telemetry transmitters and tourniquets – all completed to factory specifications.

Headquartered in Rochester Hills, Michigan, InfuSystem delivers local, field-based customer support and operates Centers of Excellence in Michigan, Kansas, California, Massachusetts, Texas and Ontario, Canada.

SUMMARY:

The DME Denials & Appeals Specialist is responsible for resolving payer denials and ensuring accurate reimbursement for durable medical equipment and wound care services, including Advanced Wound Care, Negative Pressure Wound Therapy (NPWT), and Pneumatic Compression Devices (PCDs). This role focuses heavily on appeals related to medical necessity, benefit coverage, and authorization, and serves as a subject‑matter resource for wound care and compression therapy billing.

Remote or hybrid eligibility will be evaluated based on candidate location.

Key Responsibilities:

• Review, analyze, and resolve payer denials and non‑payments
• Research, write, and submit appeals for wound care services, NPWT (Negative Pressure Wound Therapy), and PCDs 
• Interpret EOBs, payer policies, LCDs/NCDs, and denial reasons to determine next steps
• Manage assigned A/R inventories to ensure timely claim resolution
• Utilize payer portals and conduct professional phone follow‑ups as needed
• Identify denial trends related to wound care and compression therapy and share insights to reduce future issues
• Ensure payment accuracy; process adjustments and refunds as appropriate
• Accurately document all activity within internal systems
• Respond to patient and internal partner inquiries timely and professionally
• Stay current on payer medical policy updates affecting wound care and compression devices

Quality & Performance:

• Maintain above‑average productivity and quality scores
• Participate in ongoing audits, feedback, and process improvement initiatives

Qualifications:

• Associate degree or equivalent experience preferred
• 5 years of DME billing, collections, denials, and appeals experience
• Experience with wound care, NPWT (Negative Pressure Wound Therapy) and Pneumatic Compression Devices strongly preferred
• Strong knowledge of Medicare, Medicaid, Workers’ Compensation, and commercial payers
• Proficient with ICD‑10, CPT, and HCPCS coding
• Experience with NikoHealth, HDMS, and Waystar preferred
• Strong analytical, communication, and organizational skills
• Proficient in Microsoft Word, Excel, and Outlook

Additional Information

• No supervisory responsibilities
• Standard office or remote work environment
• Reasonable accommodations may be made for individuals with disabilities

Comprehensive Benefit Package Includes:

• Health, Dental, Vision
• Life Insurance, STD & LTD
• 401(k) with a specified Company Match
• Employee Stock Purchase Program
• Tuition Assistance
• Generous Paid Time Off plan
• Paid Parental Leave
• Employee Assistance Program
• Competitive Pay
• Direct Deposit
• Employee Referral Bonus