DME Insurance Compliance & Documentation Specialist with Brightree Software Knowledge

Review of accounts/orders to ensure all proper documents and guidelines are followed to include, but not limited to; active policy, DME covered benefits, proper ICD 10, valid med docs, proper HCPC codes - Must be familiar with Insurance payors (Medicare, Medicaid, UHC, BCBS, Presbyterian, Humana, Aetna Tricare etc) to include: - Understanding of DME qualifications for each payor listed and for multiple types of DME. Oxygen, Wheelchairs, Front Wheeled walkers, 4 wheel walkers, Hospital Beds etc. - Medicare knowledge of Oxygen to include: qualifying Sat's, Nocturnal vs 24/7, Same/Similar, O2 rental cap, O2 HCPC codes - Ability to identify cap rental items vs Purchase Items and ensure proper coding of the product dispensed - Understanding of Insurance eligibility and benefits. Knowledge of Deductible, copay and coinsurance and COB - Familiar with use of Medicare CGS Portal, verifying same/similar, and LCD's - Navigating provider portals - Knowledge/understanding with insurance denials - Familiar with intake process for patient account to ensure completion - Able to identify valid RX and interpret clinical notes for medical need - Familiar with ICD 10 coding to identify qualifying Diagnosis as required for certain DME items - Brightree Knowledge - able to navigate thru portal to locate, eligibility, med docs, notes - Able to identify and familiar with required documents to bill specific payors (DT, POC, ABN Home assessment etc)