What are the responsibilities and job description for the DME Billing Specialist position at The Breastfeeding Shop?
DME Billing Specialist
Job Summary
We are seeking a full-time, detail-oriented and organized DME Billing Specialist to join our team. The DME Billing Specialist is responsible for the accurate and timely submission, follow-up, and reconciliation of durable medical equipment (DME) claims. This role plays a critical part in ensuring clean claims, maximizing reimbursements, and maintaining compliance with payer and regulatory requirements. The ideal candidate has hands-on experience with Medicare, Medicaid MCOs, TRICARE, and commercial insurance plans.
Key Responsibilities
Claims & Billing
- Submit DME claims accurately and timely to Medicare, Medicaid, TRICARE, and commercial payers
- Ensure proper use of HCPCS codes, modifiers, units, and diagnosis codes
- Verify documentation requirements including prescriptions, CMNs, medical necessity, and proof of delivery (POD)
- Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs)
- Post payments, adjustments, and denials accurately
Denials & Follow-Up
- Research, correct, and resubmit denied or rejected claims
- Manage payer follow-up for unpaid or underpaid claims
- Identify trends in denials and provide recommendations for process improvement
- Prepare and submit appeals with supporting documentation
Account Management
- Monitor accounts receivable (AR) aging and prioritize follow-up
- Communicate with payers, clearinghouses, and internal teams to resolve issues
- Maintain accurate patient and payer records within the billing system
Compliance & Accuracy
- Ensure compliance with CMS, Medicare, Medicaid, and payer-specific billing guidelines
- Stay up-to-date on changes in payer policies, fee schedules, and regulations
- Maintain HIPAA compliance and patient confidentiality at all times
The Breastfeeding Shop is for mothers who need help, guidance, with their pumps and accessories to help them with nursing their babies. We are a family-owned business and because we understand the joys and challenges of being a new mom, we have brought together a range of supplies for all mothers who choose to breastfeed or those who need access to a breast pump. www.thebreastfeedingshop.com
The Breastfeeding Shop is an equal-opportunity employer.
Job Type: Full-time
Benefits:
- Health insurance
- Paid time off
Salary : $21 - $23