About the jobNymbl Systems is an industry-leading Prosthetics and Orthotics Practice Management software suite. Our mission is to empower healthcare providers with intelligent software solutions.Job Summary:We are seeking a skilled and detail-oriented individual to join our team as an HME/DME Medical AR Specialist. In this role, you will be responsible for reviewing denied and rejected claims and ensuring compliance with relevant regulations and guidelines. You will be responsible for correction and properly resubmitting claims, creating appeals, sending redetermination and reconsideration requests as well as responding to Additional Documentation Requests (ADRs) and Prepayment Reviews. The ideal candidate will have a solid understanding of medical billing procedures, excellent analytical skills, and strong attention to detail. This is a crucial position within our organization, as accurate and timely denial handling directly impacts our revenue cycle and financial stability. This is a remote position with the expectation of regular work hours and the ability to work in a team-oriented environment.Responsibilities:- Follow up on unpaid or denied claims, appealing when necessary, and provide necessary documentation to support the claim.- Process, scrub and submit secondary, tertiary, etc. medical claims for HME, DME, & O&P services provided to patients in compliance with all relevant guidelines, government regulations, and company policies.- Verify patient insurance coverage and eligibility for O&P services, ensuring accurate information is recorded and maintained.- Review and analyze patient medical records, HME, DME, and O&P prescriptions, and supporting documentation to ensure appropriate coding and billing.- Assign appropriate CPT, HCPCs, and ICD-10 codes to accurately reflect the services provided.- Communicate with healthcare providers, physicians, and insurance companies to resolve billing discrepancies, obtain additional information, and address claim denials or rejections.- Stay updated on changes in medical billing and coding regulations, guidelines, and insurance requirements.- Maintain confidentiality of patient information and adhere to HIPAA guidelines.- Collaborate with the billing team and other departments to ensure accurate and efficient billing processes.- Provide training and guidance to staff members on O&P billing procedures and regulations.- Other duties as may be assigned to you from time to time.Candidate Requirements:- High school diploma or equivalent; certification or associate degree in medical billing and coding is preferred.- 2+ years of relevant experience handling medical claim denials, appeals, resubmissions, redeterminations, Additional Documentation Requests (ADRs), Prepayment Reviews, etc.- Experience in Orthotics or Prosthetics is strongly preferred, Home Medical Equipment or Durable Medical Equipment will be considered.- Strong knowledge of medical billing and coding practices, including CPT, HCPCS, and ICD-10 coding systems.- Knowledge of insurance guidelines, regulations, and reimbursement policies related to HME, Durible Medical equipment E, Complex Rehab Technologies and O&P services.- Familiarity with claim submission processes, including electronic claim submission, paper claim submission and coordination of benefits.- Proficient in using billing software, electronic health records (EHR), and other relevant computer systems.- Excellent attention to detail, analytical skills, and problem-solving abilities.- Strong communication skills, both written and verbal, with the ability to effectively interact with healthcare professionals, insurance companies, and patients.- Ability to work independently and prioritize tasks in a fast-paced environment.- Suitable work from home environment.- Knowledge of HIPAA regulations and patient privacy guidelines.Candidate Preferences:- Credentialing, enrollment, and accreditation experience would be preferred.- Understanding of medical terminology and HME, DME, and O&P terminology is highly desirable.*This job description is intended to provide a general overview of the responsibilities and requirements of the position. It is not exhaustive, and additional duties may be assigned as needed.Featured benefits- Medical insurance- Vision insurance- Dental insuranceInterested in applying? Email us at Info@NymblSystems.com.Posted on Nov 9, 2023.