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TYPE OF WORK
Full Time
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SALARY
$5/hr
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HOURS PER WEEK
40
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DATE UPDATED
Aug 6, 2026
DME Billing Specialist
Employment Type: Full Time
Experience Level: Mid Level (2 to 4 years)
Department: Revenue Cycle Management / Billing
Reports To: Billing Manager or RCM Supervisor
We are seeking an experienced DME Billing Specialist to manage the full billing cycle for durable medical equipment claims. This role is responsible for accurate claim submission, denial resolution, and compliance with Medicare DMEPOS and private payer requirements. The ideal candidate has hands-on experience with HCPCS coding, CMN documentation, and payer specific billing rules for DME.
Key Responsibilities
Prepare and submit clean claims to Medicare, Medicaid, and commercial payers for DME items including HCPCS Level II coding
Verify insurance eligibility and benefits prior to billing and confirm coverage criteria under Medicare DMEPOS policy
Obtain and track Certificates of Medical Necessity (CMNs) and Detailed Written Orders (DWOs) required for reimbursement
Manage prior authorization requests and track approval status through payer portals
Apply appropriate modifiers such as KX, GA, GY, and GZ based on medical necessity documentation and ABN status
Monitor claim status through clearinghouses and resolve rejections before resubmission deadlines
Post payments and reconcile ERA/EOB documents against expected reimbursement rates
Identify and appeal denied claims within payer timely filing limits, drafting appeal letters supported by medical records
Stay current with Medicare Administrative Contractor (MAC) local coverage determinations (LCDs) for the applicable jurisdiction
Track Competitive Bidding Program requirements for applicable product categories and zip codes
Maintain compliance with HIPAA regulations when handling protected health information
Collaborate with intake, sales, and clinical staff to ensure documentation supports billed items
Meet monthly targets for days in accounts receivable, denial rate, and clean claim rate
Required Qualifications
2 to 4 years of experience in DME billing or durable medical equipment revenue cycle
Working knowledge of HCPCS Level II coding, ICD 10 CM, and CPT as applied to DME claims
Understanding of Medicare DMEPOS Supplier Standards and PECOS enrollment requirements
Experience with CMN forms, Advance Beneficiary Notices (ABNs), and prior authorization workflows
Familiarity with major DME billing software (Brightree, Fastrack, HME/DME specific platforms) or equivalent
Knowledge of clearinghouse claim submission and rejection resolution
Strong understanding of denial management and appeals process across Medicare, Medicaid, and commercial payers
High school diploma or equivalent required; Associate degree in health information management, billing and coding, or related field preferred
Preferred Qualifications
Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) credential
Experience with Medicare jurisdictions and current MAC assignments (CGS, Noridian)
Experience auditing claims for compliance with LCDs and National Coverage Determinations (NCDs)
Working knowledge of the DMEPOS Competitive Bidding Program and single payment amounts
Work Environment
This position is remote with standard business hours.
Compensation - $5/hour
