Dme & Pharmacy Medical Biller

Description:

Brightlyo is seeking an experienced DME & Pharmacy Medical Biller to manage the complete billing cycle for durable medical equipment (DME) and pharmacy claims. The ideal candidate will ensure accurate claim submissions, resolve denials, and maintain compliance with Medicare, Medicaid, and private insurance regulations. This hybrid role offers a flexible work environment with both on-site and remote collaboration.

Key Responsibilities:

• Submit DME and pharmacy claims (CMS-1500, UB-04) with accurate HCPCS, ICD-10, and NDC codes.

• Verify medical necessity and obtain prior authorizations for DME/pharmacy orders.

• Investigate and appeal claim denials (e.g., missing CMN forms, NDC mismatches).

• Track and resolve rejections (e.g., KX modifiers, capped rental issues, COB errors).

• Ensure compliance with Medicare DME MAC, Medicaid, and private payer policies.

• Stay updated on LCD/NCD guidelines for DME and pharmacy billing.

• Collaborate with DME suppliers, pharmacies, and clinicians to maintain accurate documentation.

• Assist patients with coverage inquiries and payment plans.

• Generate reports on DME/pharmacy claim performance (denial trends, clean claim rates).

• Support HIPAA/SOX audits and maintain billing records.

Qualifications:

Must-Have:

• 3+ years of experience in DME and/or pharmacy billing (Medicare Part B/D, Medicaid, commercial payers).

• Expertise in DME-specific codes (HCPCS Level II, KX/GA/GZ modifiers) and pharmacy NDC coding.

• Proficiency in DME billing software (e.g., Brightree, Adaptis) or pharmacy billing systems (e.g., RxBiller, CPR+).

• Strong knowledge of CMN forms, DME MAC policies, and pharmacy prior authorization workflows.

• Ability to interpret EOBs, remittance advice (RA), and resolve underpayments.

Preferred:

• Certification in DME billing (CBDCO, CRCP) or pharmacy billing (CPB).

• Experience with oxygen, diabetic supplies, or infusion therapy billing.

• Familiarity with EPIC, Cerner, or other EHRs for DME/pharmacy documentation.

Soft Skills:

• Detail-oriented with a zero-tolerance for claim errors.

• Self-motivated for hybrid work (remote + on-site collaboration).

• Excellent communication skills to bridge providers, payers, and patients.

Why Join Us?

✔ Higher Pay & Bonuses – Competitive salary + attendance & performance bonuses
✔ Medical Coverage – Free treatment at panel hospitals
✔ In-House Meals – Complimentary lunch & snacks daily
✔ Pick & Drop – Dedicated transport for female employees
✔ Fuel Allowance – Up to 50 liters/month for male staff
✔ Gym Membership – Free i-Active Gym subscription
✔ Work Incentives – Monthly rewards for top performers
✔ Hybrid Flexibility – Balance office & remote work