RCM Wound Care Claim Denial Specialist

InfuSystem is a leading national health care service provider, facilitating outpatient care for durable medical equipment manufacturers and health care providers by delivering ambulatory pumps and supplies, along with related clinical, biomedical and billing services, to practices and patients nationwide. With a comprehensive suite of services, InfuSystem improves clinician access to quality medical equipment and promotes patient wellness and safety while reducing the overall cost of infusion care.

InfuSystem offers Oncology, Pain Management and Wound Care therapies, including Negative Pressure Wound Therapy. The company’s Durable Medical Equipment (DME) Services are composed of direct payer rentals, pump and consumable sales, and biomedical services and repair, including on-site and depot services. InfuSystem provides the sale, rental, lease and associated supplies, including infusion pumps, nerve blocks for acute pain, nerve block catheters, postoperative pain pumps, central venous catheters, IV pumps, pole-mounted pumps, syringe pumps, enteral pumps, Huber needles, clean room supplies, IV extension tubing, pump tubing, ambulatory pumps, replacement pumps, disposable products, central venous access devices, closed system transfer devices, negative pressure wound therapy vacs, wound vac, and chemotherapy and oncology infusion pumps. Biomedical services include both on-site and depot preventive maintenance, repair and warranty services, ranging from equipment inspections to extensive repairs, including compression device systems, defibrillators, EKG machines, electrosurgical units, external pacemakers, humidifiers, infusion pumps, LCDs, light sources, modules, patient monitors, printers, pulse oximeters, telemetry transmitters and tourniquets – all completed to factory specifications.

Headquartered in Rochester Hills, Michigan, InfuSystem delivers local, field-based customer support and operates Centers of Excellence in Michigan, Florida, Kansas, California, Massachusetts, Texas and Ontario, Canada.

Summary

The RCM Wound Care Claim Denial Specialist is responsible for the management of activities relative to third party payer collections. This includes, but is not limited to, performing accounts receivable management, following up on denials/non-payments, filing appeals for medical necessity, benefit coverage, etc. This position should have collections work experience in DME and wound care services. This position will have demonstrated proficiency in working a variety of payers and wound care services. Quality and productivity scores must be above average. This individual will also act as a knowledge source for the department for wound care services. ***Remote versus hybrid work eligibility will be evaluated based on the applicant’s location***

In This Role, The Ideal Candidate Will

• Monitor accounts receivable agings to ensure timely resolution of claims
• Ability to identify and report any trends causing future potential denials
• Ensure payment accuracy
• Learn and assist with Collection processes for all business line or as assigned.
• Must be able to interpret payer explanation of benefits (EOBs)
• Review payer denials, analyze accounts, and determine the next appropriate steps to achieve payment success
• This will include payer portal review and phone calls to payers. Successful candidates will have the ability to clearly and concisely communicate the issues that they are seeing and request payer representatives to assist with resolution.
• Conduct insurance reverification as needed through various eligibility tools
• Research, write, and submit appeals as appropriate
• Process third party payer correspondence, refunds, and adjustments
• Accurately and thoroughly document the pertinent collections activities in appropriate systems
• Possess knowledge on billing guidelines and modifiers used for Advanced Wound Care and Negative Pressure Wound Therapy
• Have experience in submitting appeals for Advanced Wound Care and Negative Pressure Wound Therapy
• Respond to all patient inquiries timely
• Remain up to date on payer medical policy notices and changes
• Share information and ideas for process improvements with team
• Comply with all work instructions, policies, and behavioral expectations
• Performs other related duties as assigned and required
  

QUALITY AND QUANTITY OF WORK

Team members will be responsible for hitting regular productivity targets with a high level of quality. Quality audits will be performed on a regular basis and feedback and education will be provided to the team member to help support growth and development.

Supervisory Responsibilities

This job has no supervisory responsibilities.

The Ideal Candidate Will Have The Following Qualifications

• Associate degree or equivalent preferred; minimum five years related experience; or equivalent combination of education and experience
• Five years of wound care billing/collections experience preferred
• Organizational skills
• Good troubleshooting skills
• Strong attention to detail
• Proficient with Word, Excel, Outlook
• Operate Express/HDMS/Waystar proficiently
• Understanding of insurance guidelines including Medicare, Medicaid, Workers Compensation, and all Commercial managed-care plans
• Ability to handle inquiries and respond via telephone or in writing
• Ability to explain and resolve collections-related questions/issues to patients, sales representatives, and facilities
• Proper use of ICD-10, CPT, and HCPCS codes
• Ability to independently meet tight deadlines in a project-based atmosphere

Personal And Professional Attributes

Required to understand and have a commitment to the philosophy, mission, values, and vision of the business and will be required to demonstrate these values with his/her daily actions. The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:

• Strong work ethic
• Sound judgment
• Proven written and verbal communication skills
• Natural curiosity to pursue issues and increase expertise
• Passionate about InfuSystem and serving customers and patients
• Strives to make an impact on improving our business processes and results
• Exemplary honesty and integrity
• Ability to collaborate effectively and work selflessly as part of a team

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Comprehensive Benefit Package To Include

• Health, Dental, Vision
• Life Insurance, STD & LTD
• 401(k) with a specified Company Match
• Employee Stock Purchase Program
• Tuition Assistance
• Generous Paid Time Off plan
• Paid Parental Leave
• Employee Assistance Program
• Competitive Pay
• Direct Deposit
• Employee Referral Bonus