What are the responsibilities and job description for the DME Wound Care Claims Denial Specialist position at InfuSystem?
InfuSystem is a growing healthcare company that enables the continuity of patient care with integrated therapy services, biomedical services, and durable medical equipment serving all 50 states and Canada. InfuSystem offers Oncology, Pain Management, and Wound Care therapies, including Negative Pressure Wound Therapy. We deliver improved patient outcomes and high patient satisfaction.
As a leader in our field, our mission is to provide quality integrated therapy services to patients and medical practices, including a 24-hour clinical support hot line. Service is always our highest priority. Patients and clinicians in more than 2,150 sites of care trust InfuSystem as their full-service source for cost-effective integrated therapy services and durable medical equipment.
SUMMARY :
The DME Wound Care Claims Denial Specialist is responsible for the management of activities relative to third party payer collections. This includes, but is not limited to, performing accounts receivable management, following up on denials / non-payments, filing appeals for medical necessity, benefit coverage, etc. This position should have collections work experience in DME and wound care services. This position will have demonstrated proficiency in working a variety of payers and wound care services. Quality and productivity scores must be above average. This individual will also act as a knowledge source for the department for wound care services.
IN THIS ROLE, THE IDEAL CANDIDATE WILL :
- Monitor accounts receivable agings to ensure timely resolution of claims
- Ability to identify and report any trends causing future potential denials
- Ensure payment accuracy
- Must be able to interpret payer explanation of benefits (EOBs)
- Review payer denials, analyze accounts, and determine the next appropriate steps to achieve payment success
This will include payer portal review and phone calls to payers. Successful candidates will have the ability to clearly and concisely communicate the issues that they are seeing and request payer representatives to assist with resolution.
QUALITY AND QUANTITY OF WORK
Team members will be responsible for hitting regular productivity targets with a high level of quality. Quality audits will be performed on a regular basis and feedback and education will be provided to the team member to help support growth and development.
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS :
PERSONAL AND PROFESSIONAL ATTRIBUTES :
Required to understand and have a commitment to the philosophy, mission, values, and vision of the business and will be required to demonstrate these values with his / her daily actions. The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes :
PHYSICAL DEMANDS :
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT :
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
COMPREHENSIVE BENEFIT PACKAGE :
At InfuSystem, we give our employees the tools to succeed both on and off the job. Our generous benefits package provides comprehensive coverage to help you protect your health and earning power and prepare for the future. In addition, we offer perks and programs that help you grow in your career and make InfuSystem a great place to work!
