Job Description

DME / Medical Invoicing professional needed in Toms River, NJ

-DME is the process of submitting claims to Medicare, as well as Medicare Advantage plans, and private insurers for durable "medical equipment" (wheelchairs, crutches, bedrails, walkers, etc.) the reusable medical devices your facility provides to patients.

This equipment ranges from wheelchairs and oxygen tanks to hospital beds and CPAP machines.

Unlike standard medical billing, DME claims require specific documentation to prove both medical necessity and proper equipment delivery. Your facility must show:

• The equipment matches the patient's documented medical condition.
• A physician has prescribed the equipment.
• The patient received and is using the equipment correctly.
• The equipment meets quality and safety standards.

Three key players work together in DME claims processing:

• First, your facility serves as the provider , handling everything from verifying patient eligibility to submitting initial claims and managing documentation.
• Billing companies act as your facility's partner in the claims process. They handle the complex work of processing claims, managing denials and appeals, and keeping your team updated on changing regulations.
• Insurance companies complete the cycle by reviewing claims, verifying coverage, and processing payments. They set the rules for reimbursement and decide whether claims meet their requirements for payment.

- Understanding how these roles interact helps you spot potential bottlenecks in your billing process. For example, if your facility consistently faces denials for missing documentation, you might need better systems for gathering physician orders before submitting claims.

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