Insurance Billing Specialist II (DME)

Job Summary
The Billing Support Specialist II is an advanced role focused on ensuring the accuracy and efficiency of insurance billing processes. This role includes mentoring junior team members, enhancing departmental workflow, and handling complex billing tasks to ensure patient orders progress smoothly and meet compliance standards.

Key Responsibilities

• Task orders across internal systems such as Salesforce and Brightree.
• Monitor and maintain patient order queues.
• Maintain extensive knowledge of insurance coverages and markets.
• Analyze and report on daily, weekly, and monthly data.
• Partner with team members and cross-functional stakeholders to resolve issues.
• Adhere to CMS and other payer compliance guidelines.
• Meet and exceed productivity benchmarks.
• Maintain accurate medical records in accordance with HIPAA guidelines.
• Ensure compliance with all state and federal regulations.
• Identify and recommend process improvement opportunities to enhance workflow.
• Support various office or departmental projects and meetings.
• Perform miscellaneous duties and assist with tasks as assigned by management.

• Provide guidance and support to junior team members on work-related issues and departmental processes.
• Assist in monitoring team production and quality to ensure KPIs are met or exceeded.
• Actively identify and recommend solutions for process improvement opportunities.
• Analyze and report on departmental data, including daily, weekly, and monthly metrics.

Knowledge, Skills, and Abilities

• Advanced knowledge of Medicare, Medicaid, and Commercial Insurance.
• Proven ability to mentor and assist team members.
• Strong organizational and planning skills.
• Advanced conflict resolution and problem-solving skills.
• Ability to work independently and take on additional responsibilities with minimal supervision.

Qualifications

• High School diploma or equivalent (required).
• Some college or medical billing certificate (preferred).
• 2–4 years of experience with insurance billing, including Medicare, Medicaid, and Commercial Insurance (required).
• Experience with oxygen or HME billing (preferred).
• Beginner to intermediate proficiency with Microsoft Office, Oracle, Brightree, Salesforce (highly preferred).