Key Responsibilities

- Complex Denials & Appeals: Investigate, file redeterminations, and prepare appeals for high-dollar or out-of-network denied DME claims. [1, 2]

- Payer Follow-Up: Act as the subject matter expert for Medicare (e.g., CMS guidelines), Medicaid, and commercial insurance claim statuses. [1, 2]

- Claim Validation: Ensure all necessary Certificates of Medical Necessity (CMN), prior authorizations, and physician orders are accurately attached to claims before submission. [1, 2]

- Reimbursement Optimization: Monitor AR aging buckets, identify payment trends, and lead projects to reduce outstanding balances past $60$ days. [1, 2, 3]

- Team Leadership: Assist billing managers by training junior staff on DME-specific HCPCS codes, modifiers, and payer policies.

Essential Qualifications

- Experience: Typically 3+ years in medical billing and collections, with a solid focus on DME,



HME (Home Medical Equipment), or Orthotics & Prosthetics. [1, 2]

- Knowledge Base: Deep understanding of LCDs (Local Coverage Determinations), NCDs (National Coverage Determinations), and modifier usage (e.g., NU, RR, UE). [1, 2, 3, 4]

- Software Proficiency: Hands-on experience with healthcare RCM and billing software like Brightree, Medisoft, Epic, or TIMS. [1, 2, 3]

- Analytical Skills: Advanced ability to reconcile patient and insurance ledgers, calculate expected reimbursements, and write-off adjustments appropriately. [1, 2]

Pay: ₹35,000.00 - ₹60,000.00 per month

Benefits

- Flexible schedule

- Leave encashment

- Provident Fund

Work Location: In person

📌 Senior Account Receivable (AR) (Ahmedabad)
🏢 IRVx Softlabs
📍 Ahmedabad