DME Denials and Appeals 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 DME Denials and Appeals 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 claimsAbility to identify and report any trends causing future potential denialsEnsure payment accuracyLearn 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 successThis 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 toolsResearch, write, and submit appeals as appropriateProcess third party payer correspondence, refunds, and adjustmentsAccurately and thoroughly document the pertinent collections activities in appropriate systemsPossess knowledge on billing guidelines and modifiers used for Advanced Wound Care and Negative Pressure Wound TherapyHave experience in submitting appeals for Advanced Wound Care and Negative Pressure Wound TherapyRespond to all patient inquiries timelyRemain up to date on payer medical policy notices and changesShare information and ideas for process improvements with teamComply with all work instructions, policies, and behavioral expectationsPerforms other related duties as assigned and requiredQUALITY AND QUANTITY OF WORKTeam 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 experienceFive years of wound care billing/collections experience preferredOrganizational skillsGood troubleshooting skillsStrong attention to detailProficient with Word, Excel, OutlookOperate Express/HDMS/Waystar proficientlyUnderstanding of insurance guidelines including Medicare, Medicaid, Workers Compensation, and all Commercial managed-care plansAbility to handle inquiries and respond via telephone or in writingAbility to explain and resolve collections-related questions/issues to patients, sales representatives, and facilitiesProper use of ICD-10, CPT, and HCPCS codesAbility to independently meet tight deadlines in a project-based atmospherePERSONAL 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 ethicSound judgmentProven written and verbal communication skillsNatural curiosity to pursue issues and increase expertisePassionate about InfuSystem and serving customers and patientsStrives to make an impact on improving our business processes and resultsExemplary honesty and integrityAbility to collaborate effectively and work selflessly as part of a teamPHYSICAL 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, VisionLife Insurance, STD & LTD401(k) with a specified Company MatchEmployee Stock Purchase ProgramTuition AssistanceGenerous Paid Time Off planPaid Parental LeaveEmployee Assistance ProgramCompetitive PayDirect DepositEmployee Referral Bonus Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Created: 2026-04-02