Demo

DME Reimbursement Specialist

BioDerm
Newbern, TN Full Time
POSTED ON 3/6/2025
AVAILABLE BEFORE 6/6/2025

Summary

The DME Reimbursement Specialist will assist the Operations and Credentialing Teams with :

  • The preparation and review of contract proposals and renewals.
  • Liaison functions between in and out of network principals, internal departments, and external parties to ensure specifications and the resolution of issues.
  • Adhering to all Federal, State, Accreditation standards.

Essential functions

Reasonable accommodation may be made to enable individuals with disabilities to perform these essential functions.

Details

Primary Duties : Relate to I n and Out of Network P roviders

  • The review of contracts (when applicable) to ensure favorable terms for DME (Durable Medical Equipment) services.
  • The analyzation and interpretation of provider conditions, and payment structures to ensure compliance with organizational goals and regulatory requirements.
  • The proactive review of contract renewals (when applicable), assessing potential changes, and providing recommendations before finalizing agreements.
  • Resolving issues related to provider performance, payment discrepancies, and other insurance related matters in a timely and efficient manner.
  • The regular assessment of financial performance of providers, identifying areas for improvement in reimbursement rates and terms.
  • The integration or improvement of reimbursement rates and terms.
  • Staying up to date on industry trends and emerging market opportunities.
  • Competencies

    Given the level of the leadership position within the company, expectation is the leader demonstrates a proficient level of the following proficiencies / competencies.

  • Plan and organize work : Re quire the ability to create and use logical, systematic processes to achieve goals. Having the ability to visualize the steps needed to reach a goal and naturally organize the process, modifying, as necessary.
  • Interpersonal communication : Effectively communicate, develop, and foster strong working relationships with drives team growth, engagement, and productivity.
  • Collaboration : Working together to a common purpose to achieve team and business benefit. Enables individuals to work together to achieve a defined and common business purpose.
  • Deliver consistent results : Follow through tasks and goals so that support team / operations success and improvements.
  • Job Knowledge / Technical Knowledge : Level of expertise in job and the extent to which new information and skills are applied. Understands work responsibilities and adds to knowledge and skills.
  • Work environment

    In office setting

    Physical demands

    The physical demands of this position are typical related to office ergonomics.

    Travel required

    Required education and experience

  • High School Diploma, associate or bachelor's degree preferred
  • SAP proficient preferred
  • Minimum 3-5 years of DME Billing and Denial experience, 5 years preferred
  • Working knowledge of medical terminology, and wound care products
  • Excellent verbal and written communication skills.
  • Proficient with Microsoft Word and Excel.
  • Detail oriented and strong organizational skills.
  • Capable of performing basic math.
  • Must be able to recognize process deficiencies.
  • Additional eligibility requirements

    n / a

    Affirmative Action / EEO statement

    BioDerm, Inc. is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our Management Team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

    Other duties

    Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

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