ACU-Serve Careers

Be a Part of our Team

It is an exciting time at ACU-Serve where we are growing and expanding our services. We would love to have you be a part of it. If you feel you would be a good fit for our team please apply below. ACU-Serve is one of the top 100 fastest growing companies in Northeastern OH and over 20 years, ACU-Serve has earned a reputation as the most trusted HME/DME and Home Infusion billing and collection service in the industry. The company’s offerings allow clients to streamline billing processes and comply with the ever-changing federal and insurance industry regulations, to collect more, faster. With our “Office in a box” strategy we have found a way to successfully hire and manage employees from anywhere regardless of location and train them to be a part of our fast-growing team.

Click on a Job Title below to see the details and then click the apply link to email your Resume and Cover Letter to careers@acuservecorp.com. Please attach your Resume and Cover Letter as a Microsoft Word Document or a PDF.

Complex Rehab Billing & Claims Resolution Specialist

POSITION SUMMARY

The Complex Rehab Billing & Claims Resolution Specialist position resolves issues with unpaid insurance claims for an assigned client load. It researches incoming denials from insurance companies, initiates the collection process through telephone contacts, letters, contracts, websites, etc. and research payor and government websites and/or medical resources to identify payor claim requirements required to resolve open accounts receivable and works to minimize write-offs by exhausting all resolution options. It also leverages technology and identifies and reports process inefficiencies and makes recommendations for continuous improvement and opportunities that will enhance revenue flow.

DUTIES & RESPONSIBILITIES

Maintains timely and accurate collections of accounts receivable balances.
Knowledge of Complex Rehabilitative Equipment including but not limited to coding, modifiers, narrative information, parts, repairs, and loaner equipment.
Ability to analyze and/or gain knowledge to interpret Commercial, Medicaid, Medicare, and Medicare Advantage Plan Local Coverage Determinations and Policy Guidelines.
Understand the methodology of expected calculation of payments for Complex Rehabilitative Equipment as per Medicare Guidelines or contracted payer rates.
Ability to effectively communicate with payers via written appeals and/or telephone reprocessing regarding inconstancies with short paid/erroneously denied claims.
Interfaces with appropriate personnel and managers or provider representatives to exchange information on collection accounts.
Performs other related duties as assigned by management

QUALIFICATIONS & EXPERIENCE

Three to Five years related experience or equivalent.
Basic competence in duties and tasks.
Excellent written and verbal communication skills.
Proficient in Excel 2-3 years’ experience or more.
Acute attention to detail. Critical thinking.
Good judgement with the ability to make timely and sound decisions.
Ability to work with all levels of management.
Strong organizational, problem-solving, and analytical skills; able to manage priorities and workflow.
Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.

COMPETENCIES

Problem Solving – Identifies and resolves problems in a timely manner; Can work independently; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Oral Communication – Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Participates in meetings.
Teamwork – Balances team and individual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit/
Quantity – Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly and accurately.
Attendance – Is consistently working on time and productive.
Dependability – Follows instructions, responds to management direction, completes tasks on time or notifies appropriate person of alternative plan.

FULL-TIME/PART-TIME — Full-Time

THIS POSITION IS CURRENTLY ACCEPTING APPLICATIONS.

LOCATION — ACU-Serve Corporate Offices – Akron, OH; Remote (WFH) position

Medical Billing & Claims Resolution Specialist

DESCRIPTION

The Medical Billing & Claims Resolution Specialist position resolves issues with unpaid insurance claims for an assigned client load. It researches incoming denials from insurance companies, initiates the collection process through telephone contacts, letters, contracts, websites, etc. and research payor and government websites and/or medical resources to identify payor claim requirements required to resolve open accounts receivable and works to minimize write-offs by exhausting all resolution options. It also leverages technology and identifies and reports process inefficiencies and make recommendations for continuous improvement and opportunities that will enhance revenue flow.

POSITION REQUIREMENTS

Reviewing open AR for your designated client load to evaluate what is needed to collect the outstanding cash.
Work independently to identify and resolve reasons for denials, rejections and claims with no response in the most efficient manner possible.
Work via website, phone, fax, and any manner necessary to resolve the outstanding AR in the most efficient way possible.
Understand, locate, and review payer websites and manuals for guidance and resolution.
Evaluate high touch claims and Tier 2 claims and provide feedback to the team working the first touch on errors made or where feedback can be given to eliminate touches on the claim.
Ability to review and identify patterns of price table issues and escalate to resolve them according to contract or payer guidelines.
Ability to review and identify patterns with payers and non-payment or delayed payment. Be able to summarize and escalate in the correct manner.
Exercise good time management skills to balance the workload between multiple clients and payers and complete goals timely.
Work with payer representatives or provider representatives to identify and resolve outstanding issues. Evaluating volume to find the most efficient way to resolve the outstanding issues or start a project with the payer representatives.
Remain productive throughout the workday and communicate if more work is needed.
Communicate effectively when additional training is needed.

QUALIFICATIONS & EXPERIENCE

Demonstrate the ability to communicate, present and escalate issues to leadership at all levels of an organization, including executive level
Experience delivering client-focused solutions to customer needs
Strict adherence to company philosophy/mission statement/vision and goals
Excellent interpersonal skills and communication with all levels of management and employees
Critical thinker who can analyze situations and make decisions that support company goals and help to solve problems
Strong verbal skills with a mix between soft and hard skills
Strong motivational and listening skills
Strong written communication skills
Strong time management skills
Able to multitask, prioritize, and manage time efficiently
Able to analyze problems and strategize for better solutions
Able to effectively work denials received from Insurance Payers and review an Explanation of Benefit or Remittance Advice.
Able to utilize software efficiently by submitting claims, working payer rejections, and understanding the industry’s HCPCS and modifier combinations and diagnoses coding.

PHYSICAL EFFORT:

Work time will be spent sitting approximately 95% of the time, standing and walking approximately 5% of work time. PC Keyboarding will constitute approximately 80% of work time.

JOB STATUS — Non-Exempt

POSITION — Medical Billing & Claims Resolution Specialist

LOCATION — LOCATION — ACU-Serve Corporate Offices – Akron, OH; Remote (WFH) position

THIS POSITION IS CURRENTLY ACCEPTING APPLICATION

Infusion Intake Specialist

DESCRIPTION

ACU-Serve is one of the top 100 fastest growing companies in Northeastern OH and over 20 years, ACU-Serve has earned a reputation as the most trusted HME/DME and Home Infusion billing and collection service in the industry. The company’s offerings allow clients to streamline billing processes and comply with the ever-changing federal and insurance industry regulations, to collect more, faster. With our “Office in a box” strategy we have found a way to successfully hire and manage employees from anywhere regardless of location and train them to be a part of our fast-growing team.

The Infusion Intake Specialist must be knowledgeable of all Infusion provided by Home Medical and uphold its standard for excellence. Responsible for processing orders for various infusion products. Experience in durable medical field preferred but experience in infusion is a must. Responsible for competently and efficiently performing all tasks relative to the order intake process in a friendly, professional manner.

POSITION REQUIREMENTS

Minimum of 1 year of customer service experience.
Minimum of 2 years Intake experience with Pharmacy/Infusion preferred.
Ability to work multiple state insurance plans preferred.
CPR+ software experience preferred.
HS diploma/GED.
Strong computer skills including strong keyboarding skills.
Experience with MS Word and Excel required.
Proven ability to use formal business language to communicate effectively in written form including spelling and punctuation.
Excellent verbal communication skills and ability to communicate with tact and diplomacy and maintain a professional approach when confronted with difficult situations (e.g., the ability to not personalize negative customer comments and maintain a cordial manner).
Strong attention to detail.
Strong negotiation and problem-solving skills.
Ability to multi-task.
Results-oriented self-starter with a can-do attitude, a sense of urgency and ability to complete tasks in a timely manner.
Proven ability to review current processes and procedures and suggest process improvements or solutions.
Able to work with others with diverse personalities.
A good candidate will have Pharmacy Tech or Home Infusion Intake background.

FULL-TIME/PART-TIME — Full-Time

POSITION — Infusion Intake Specialist

TAGS – TAGS — DME, HME, Infusion, Medical Billing, Brightree, CPR+, Bonafide, TeamDME, Fastrack

LOCATION — ACU-Serve Corporate Offices – Akron, OH; Remote (WFH) position

DME Intake Referral Specialist

DESCRIPTION

The DME Intake Referral Specialist provides first-line communication with a variety of clients, patients, providers, and referral sources to facilitate the intake, qualification, and ordering process of durablemedical equipment (DME) and home medical equipment (HME) products, supplies, and services.

POSITION REQUIREMENTS

Maintain a working knowledge of billing, documentation, and reimbursement guidelines
including Medicare, Medicaid, third party and contracted payers.
Receive and process inquiries, escalations, and referral requests by phone, fax, task, vendor portal, and email.
Make initial contact with patients to confirm receipt of their referral.
Enter patient demographic information into the appropriate software system, create sales order
for equipment and supplies, obtain prior authorization, determine eligibility, and accurately file medical documentation.
Ensure all patient referrals are processed timely and accurately to enhance patient satisfaction
and optimize client revenue.
Gather all necessary documentation, as it relates to payer requirements, standard operating
procedures, and compliance programs.
Request appropriate medical records from clients and providers and verify all necessary
documentation is received.
Contact patients when documentation received does not meet payer guidelines to provide
updates and offer additional options to facilitate the referral process.
Serve as an advisor to providers when prescribing equipment and supplies to ensure
appropriate documentation and order requirements are met.
Maintain accurate and detailed progress notes pertaining to all aspects of the intake process.
Resolve client, patient, and provider concerns and questions by identifying problems and
coordinating appropriate corrective action.
Set up new referring providers in clients billing software system and verify licensure.
Answer inbound calls from client phone queue and return voicemails in a professional and
helpful manner.
Participate in quality reviews and achieve performance results at or above the threshold
established by leadership.
Maintain confidentiality of patient health information and adhere to HIPAA guidelines.
Conduct self in a manner reflecting credit on the company and actively promote and foster
relationships.
Provide exceptional customer service to clients, patients, and providers through friendly, caring,
informative and professional interactions.
Perform other duties as assigned by management.

EDUCATION

High School diploma or GED

EXPERIENCE

Possess in-depth knowledge of the DME/HME industry, including the intake process,
documentation, billing, compliance, performance management and medical terminology.
Ability to perform with a high degree of independent judgement, discretion, and confidentiality; and make complex decisions within a short period of time.
Exceptional communication skills, both verbal and written, as well as excellent organizational skills.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Able to adapt to and work effectively in a fast paced and changing environment with multiple priorities.
Must be able to work independently with minimal supervision and produce timely and accurate work
Strong knowledge of computer functions and basic Microsoft Office applications.

SKILLS

Personal Accountability – Accepts responsibility for one’s actions, decisions, performance, and behaviors as well as ensuing consequences.
Critical Thinking and Decision Making – Utilizes tools and techniques critical to the decision making process and possesses the ability to accurately analyze situations and reach productive decisions based on informed judgment.
Effective Communication – Ability to exchange ideas, thoughts, opinions, knowledge, and data so that the message is received and understood with clarity and purpose.
Initiative – Ability to assess a situation and independently take action to address it; willingness to seek out work and the drive to accomplish goals.
Interpersonal Relationships – Understanding of techniques used to develop and maintain effective relationships with others and work in a constructive and collaborative manner.
Active Listening – Listens attentively with genuine interest to a speaker, understands what they’re saying, responds and reflects on what is being said, and retains the information.
Planning and Organizing – Proactively plans and establishes priorities and effectively utilize both time and resources to achieve important goals and objectives.
Teamwork – Ability to collaborate with others to achieve a common goal or complete a task in the most effective and efficient way.

DME Documentation Specialist

DESCRIPTION

The DME Documentation Specialist must be knowledgeable of all equipment and supplies provided by Home Medical and uphold its standard for excellence. Responsible for processing orders for various medical equipment. Experience in durable medical field preferred specifically insurance and medical terminology. Responsible for competently and efficiently performing all tasks relative to the order intake process in a friendly, professional manner.

KEY DOCUMENTATION SPECIALIST JOB RESPONSIBILITIES

Collects, reviews and requests medical documentation required to support medical necessity to submit for Prior Authorization.
Submits and maintains prior authorizations and all certificates of medical necessity (CMN)
Requests documentation to support medical necessity and ongoing need for various durable medical equipment items including and not limited to oxygen and sleep therapy.
Creates initial, revised and recertification certificates of medical necessity within various DME billing software systems.
Reviews incoming CMN’s and medical records for accuracy.
Reviews and completes stop hold reports to resolve and release held revenue to various payers.
Knowledgeable of Medicare, Medicaid and other insurance companies’ rules regarding CMN’s, detailed written orders and prior authorizations.
Ability to converse with clinicians and office staff to follow up on outstanding requests and to describe information required.

KEY DOCUMENTATION SPECIALIST QUALIFICATIONS

Minimum of 1 year of experience in durable medical billing requirements; understanding Durable Medical Equipment intake processes including insurance verification, and Prior Authorization Requests. Experience working in DME billing platform – Brightree.
Knowledge of requirements for Medicare, Medicaid, and Commercial payers as for what qualifies a patient for coverage of prescribed equipment.
HS diploma/GED.
Knowledge of documentation requirements for multiple HCPCs
Strong computer skills including MS Word, Excel and strong keyboarding skills.
Proven ability to use formal business language to communicate effectively in written form including spelling and punctuation.
Strong attention to detail.
Task oriented while performing in a fast-paced environment.
Results-oriented self-starter with a can-do attitude, a sense of urgency and ability to complete tasks in a timely manner.
Proven ability to review current processes and procedures and suggest process improvements or solutions.
Able to work with others with diverse personalities.
Good problem-solving skills including managing crisis situations calmly and professionally as well as the ability to maintain confidential patient, financial and company information, following HIPAA guidelines.

JOB TYPE — Full-Time

PAY — $15.00 – $18.00 per hour

LOCATION — Remote (WFH) position

THIS POSITION IS CURRENTLY ACCEPTING APPLICATION

Intake Specialist Supervisor

DESCRIPTION

The Intake Specialist Supervisor is responsible for assisting Management in overseeing and directing the daily activities of the intake department’s employees to ensure the intake, qualification, and ordering process of durable medical equipment (DME) and home medical equipment (HME) products, supplies, and services is completed in a timely, eﬃcient, and knowledgeable manner.

RESPONSIBILITIES

Work in close liaison with the leadership team and assigned clients, as the main point of contact, to oversee daily routine tasks, address issues and concerns, prepare meeting agendas, participate in client calls, compile analytical reports, and provide operational updates.
Maintain a working knowledge of clients DME/HME products and services as well as billing, documentation, and reimbursement guidelines including Medicare, Medicaid, third party and contracted payers.
Develop and maintain standard operating procedures (SOP) for client accounts; implement and communicate updates and changes as needed.
Organize on-going team meetings and huddles to establish an open line of communication, encourage collaboration, and provide direction and updates.
Oversee assigned teams’ workload, productivity, and coverage; assume responsibility of, or appropriately delegate, tasks to ensure all patient referrals are processed timely and accurately.
Conduct quality assurance audits to verify medical necessity and documentation requirements of payors and regulatory bodies are met and are in accordance with ACU-Serve/client’s SOPs.
Monitor and document employee performance results, identify team and individual training needs, and assist in developing plans for immediate and long-term performance improvements.
Assist Management with human resource duties, including employee evaluations, Teramind reviews, coaching, corrective action, updating employee files, time off approvals, and timecard/invoicing review and corrections.
Responsible for escalation management related to intake issues and ensuring escalation processes are followed, completed in a timely manner, and client/patient communications are taking place.
Resolve client, patient, and provider concerns and questions by identifying problems and coordinating appropriate corrective action.
Provide training, guidance, motivation, and support to enable employees to become more proficient and to broaden their knowledge and capabilities
Promote a supportive environment in which employees are encouraged to solve problems and address patient issues.
Maintain confidentiality of patient health information and adhere to HIPAA guidelines.
Lead by example, conduct self in a manner reflecting credit on the company, and actively promote and foster relationships.
Provide exceptional customer service to clients, patients, and providers through friendly, caring, informative and professional interactions.
Assist assigned team members with day-to-day intake duties and responsibilities.
Perform other duties as assigned by management.

QUALIFICATIONS

Minimum 5 years Durable Medical Equipment electronic billing experience with knowledge of commercial and government payers.
Cash Posting experience in Brightree, Fastrack, Bonafide or CPR+ required.
Proven experience as a manager, department lead/supervisor, or similar role
Proficient in Microsoft Office products (Excel, Word, Outlook etc.)
Knowledge of HIPAA requirements when dealing with PHI
Proven critical thinking skills required
Knowledge of insurance payer requirements

ADDITIONAL REQUIREMENTS

Must possess an in-depth knowledge of the DME/HME industry, including the intake process, documentation, billing, compliance, performance management and medical terminology.
Ability to perform with a high degree of independent judgement, discretion, and conﬁdentiality; and make complex decisions within a short period of time.
Exceptional communication skills, both verbal and written, as well as excellent organizational skills.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Able to adapt to and work eﬀectively in a fast paced and changing environment with multiple priorities.
Must be able to work independently with minimal supervision and produce timely and accurate work.
Strong knowledge of computer functions and basic Microsoft Oﬃce applications.
Previous experience in managing or supervising others preferred.

SKILLS

Servant Leadership – Commits to serving others with integrity and humility while encouraging excellence and growth in those they lead.
Personal Accountability – Accepts responsibility for one’s actions, decisions, performance, and behaviors as well as ensuing consequences.
Critical Thinking and Decision Making – Utilizes tools and techniques critical to the decision-making process and possesses the ability to accurately analyze situations and reach productive decisions based on informed judgment.
Effective Communication – Ability to exchange ideas, thoughts, opinions, knowledge, and data so that the message is received and understood with clarity and purpose.
Initiative – Ability to assess a situation and independently take action to address it; willingness to seek out work and the drive to accomplish goals.
Interpersonal Relationships – Understanding of techniques used to develop and maintain eﬀective relationships with others and work in a constructive and collaborative manner.
Active Listening – Listens attentively with genuine interest to a speaker, understands what they’re saying, responds and reﬂects on what is being said, and retains the information.
Planning and Organizing – Proactively plans and establishes priorities and eﬀectively utilize both time and resources to achieve important goals and objectives.
Teamwork – Ability to collaborate with others to achieve a common goal or complete a task in the most eﬀective and eﬃcient way.

Payment Posting Specialist

POSITION SUMMARY

A Payment Posting Specialist is responsible for the expedient and accurate posting of payments received through medical billing software.

DUTIES & RESPONSIBILITIES

Payment Entry – completes payment entry in a timely and accurate manner including:
- Posts payments to medical billing software (Electronic Remittance Notices (ERN’s) & Manual posting responsibilities)
- Records batch totals
- Balances batches and runs transaction reports
- Verifies all EFT deposits and scanned checks have been posted by month end
- Properly communicates and documents payment denials in the medical billing software and to the appropriate billing representative in a timely manner.
- Identifies any payments not being paid at the allowed/contracted amount and communicates this to the appropriate billing representative – AR and/or Director.
- Accurately reading Explanation of Benefits and applying payments & adjustments to corresponding accounts
- Balance transferring deductibles & co-insurances accurately through medical billing software to either secondary payer or patient.
- Maintains professional knowledge regarding medical billing and coding procedures, insurance carriers, federal programs, etc.

QUALIFICATIONS & EXPERIENCE

DME payment posting experience preferred.
Excellent written and verbal communication skills
Strong attention to detail and affinity for working with numbers required
Must have knowledge of word, excel, and power point
Knowledge of reading and interpreting Explanation of Benefits (EOB) required
Knowledge of processes pertaining to contractual and allowable adjustments, balance transfers, deductibles, & coinsurance required.
Brightree and/or Bonafide billing software experience required.
High School Diploma or equivalent required.
Minimum of two years of medical payment posting experience required.
Candidates must be able to work with high volume of work while maintaining a strong attention to detail, accuracy, and demonstrate excellent oral and written communication skills.
Computer skills required to operate practice management system (i.e., use Window operating system, conduct Internet searches, communicate by email, etc.)

PHYSICAL EFFORT:

Work time will be spent sitting approximately 90% of the time, standing and walking approximately 10% of work time. PC Keyboarding will constitute approximately 80% of work time. No travel required

JOB TYPE — Full-Time

LOCATION — 100% Remote (WFH) position

COVID-19 Considerations — This position is 100% remote with no patient or close contact, and no travel required

Quality Assurance/Audit Analyst

POSITION SUMMARY

The Claims Analyst is responsible to perform quality reviews for both pre-pay and post-pay audits as well as Quality Assurance reviews of orders prior to delivery and/or confirmation according to established guidelines that assist management in monitoring the quality, consistency, and effectiveness of business processes, procedures and related SOP’s. Address ongoing questions, issues and escalations from both ACU-Serve employees as well as our clients and provide clear answers and easy access to training and other resources and educational material that can answer these issues. Help to develop and organize a database of information and resources to ensure ease of navigation and interpretation and maximum clarity for both ACU-Serve employees and our clients.

DUTIES & RESPONSIBILITIES

Perform quality reviews for both Pre-Pay and Post-Pay audits as well as the client’s orders prior to and/or confirmation, according to established guidelines, that assist management in monitoring the quality, consistency and effectiveness of business processes, procedures and related tools. Specifically:
- Follow defined audit processes in conducting quality reviews;
- Keep current on new coding and billing guidelines, federal and state initiatives;
- Ensure the consistent use of current codes, correct information, documentation and departmental procedures by monitoring their use and identifying any deficiencies;
- Prepare summaries for management of quality review results, including basic analysis of identified deficiencies;
- Reduce quality related errors by making recommendations to increase the efficiency of operations.
Assist with policy, procedure development and implementation as it relates to the claim review processes.
Review coding variances including supporting documentation, review of old and new procedure codes, consult and collaborate Director of Compliance as necessary.
Prepare supporting documentation as necessary.
Based on audits and claims reviews, prepare supporting documentation requests for configuration changes to ensure that configuration mirrors provider contract.
Keep current on new coding and billing guidelines, federal and state initiatives. Educate other departments on new/changes to regulations as necessary.
Coordinate recoupment efforts with Director of Compliance due to billing errors and over payments.
Respond to provider inquiries regarding recoupments in writing and/or verbally when necessary.
Perform departmental quality audits.
Produce and deliver monthly a summary report of changes to the Director of Compliance; include relevant source documents.

QUALIFICATIONS & EXPERIENCE

Must have knowledge of payor requirements for billing, auditing, and/or contracting with a strong background of Medicare LCD requirements; and
Excellent written and verbal communication skills; and
Must have knowledge of word, excel, and power point; and
Demonstrated ability to develop strong business partnerships and relationships with payors; and
Work closely with other internal customers.

PHYSICAL EFFORT — Work time will be spent sitting approximately 90% of the time, standing and walking approximately 10% of work time. PC Keyboarding will constitute approximately 80% of work time. May require some travel.

Clinical Quality Assurance/Audit Analyst

POSITION SUMMARY

DUTIES & RESPONSIBILITIES

Perform quality reviews for both Pre-Pay and Post-Pay audits as well as the client’s orders prior to and/or confirmation, according to established guidelines, that assist management in monitoring the quality, consistency and effectiveness of business processes, procedures and related tools. Specifically:
- Maintains current knowledge of respiratory homecare techniques and relevant respiratory therapy concepts;
- Provides internal customer support on various types of respiratory care equipment including but not limited to oxygen therapy, nebulization therapy, apnea monitoring, suctioning, PAP, invasive and non-invasive ventilation;
- Follow defined audit processes in conducting quality reviews;
- Keep current on new coding and billing guidelines, federal and state initiatives;
- Ensure the consistent use of current codes, correct information, documentation and departmental procedures by monitoring their use and identifying any deficiencies;
- Prepare summaries for management of quality review results, including basic analysis of identified deficiencies;
- Reduce quality related errors by making recommendations to increase the efficiency of operations.
Assist with policy, procedure development and implementation as it relates to the claim review processes
Review coding variances including supporting documentation, review of old and new procedure codes, consult and collaborate Director of Compliance as necessary.
Prepare supporting documentation as necessary.
Based on audits and claims reviews, prepare supporting documentation requests for configuration changes to ensure that configuration mirrors provider contract.
Keep current on new coding and billing guidelines, federal and state initiatives. Educate other departments on new/changes to regulations as necessary.
Coordinate recoupment efforts with Director of Compliance due to billing errors and over payments.
Respond to provider inquiries regarding recoupments in writing and/or verbally when necessary.
Perform departmental quality audits.
Perform quality reviews for both Pre-Pay and Post-Pay audits as well as the client’s orders prior to and/or confirmation, according to established guidelines, that assist management in monitoring the quality, consistency and effectiveness of business processes, procedures and related tools.
Produce and deliver monthly a summary report of changes to the Director of Compliance; include relevant source documents.

QUALIFICATIONS & EXPERIENCE

Must have knowledge of payor requirements for billing, auditing, and/or contracting with a strong background of Medicare LCD requirements; and
Excellent written and verbal communication skills; and
Must have knowledge of word, excel, and power point; and
Demonstrated ability to develop strong business partnerships and relationships with payors; and
Work closely with other internal customers.

PHYSICAL EFFORT:

Work time will be spent sitting approximately 90% of the time, standing and walking approximately 10% of work time. PC Keyboarding will constitute approximately 80% of work time. May require some travel. JOB TYPE — Full-Time

REPORTS TO — Director of Compliance

Infusion Billing & Claims Resolution Specialist

DESCRIPTION

This position resolves issues with unpaid insurance claims for an assigned HME/Enteral/Infusion client load. It researches incoming denials from insurance companies, initiates the collection process through telephone contacts, letters, contracts, websites, etc. and researches payor and government websites and/or medical resources to identify payor claim requirements required to resolve open accounts receivable and works to minimize write-offs by exhausting all resolution options. It also leverages technology and identifies and reports process inefficiencies and make recommendations for continuous improvement and opportunities that will enhance revenue flow.

POSITION REQUIREMENTS:

Minimum of 1 year of customer service experience.
Minimum of 1 year working with Infusion/IV billing required.
- Infusion therapies may be administered via intravenous, subcutaneous, intrathecal, intraosseous, epidural, or enteral routes that may include tube feedings through NG (Nasogastric), PEG (Percutaneous endoscopic gastrostomy), G-tube (Gastrostomy) or J-Tube (Jejunostomy).
- Medical equipment such as infusion pumps and IV supplies, dressing change kits, IV start kits, Enteral formula, and routes of administrations such as pump, gravity, or syringe.
Minimum of 2 years Billing experience with Pharmacy/Infusion preferred.
Minimum of 2 years billing Medicaid, Medicare and/or Commercial insurance required.
Ability to work multiple state insurance plans preferred.
HS diploma/GED.
Strong computer skills including strong keyboarding skills.
Experience with MS Word and Excel required.
Proven ability to use formal business language to communicate effectively in written form including spelling and punctuation.
Excellent verbal communication skills and ability to communicate with tact and diplomacy and maintain a professional approach when confronted with difficult situations (e.g., the ability to not personalize negative customer comments and maintain a cordial manner).
Strong attention to detail.
Strong negotiation and problem-solving skills.
Ability to multi-task.
Results-oriented self-starter with a can-do attitude, a sense of urgency and ability to complete tasks in a timely manner.
Proven ability to review current processes and procedures and suggest process improvements or solutions.
Able to work with others with diverse personalities.
A good candidate will have Pharmacy Tech background.

FULL-TIME/PART-TIME — Full-Time

TAGS — DME, HME, Infusion, Medical Billing, Brightree, CPR+, Bonafide, TeamDME, Fastrack

POSITION — Medical Billing Collections & Resolution Specialist

LOCATION — ACU-Serve Corporate Offices – Akron, OH; Remote (WFH) position