About the Role:
We are a Medicare-focused DME company specializing in Continuous Glucose Monitoring (CGM). As we bring billing operations fully in-house, we are hiring an AR & Denials Specialist to actively work Medicare accounts receivable, denials, and follow-ups for CGM claims.
This role is for someone who understands how Medicare AR actually gets paid — not just working queues, but resolving denials, following up with MACs, and recovering cash.
This is not a call-center collections role and not Medicare Advantage billing.
Key Responsibilities:
Accounts Receivable (AR) Follow-Up:
- Work Medicare Part B DME AR on CGM claims
- Follow up on unpaid and underpaid claims
- Contact Medicare MACs as needed to resolve claim issues
- Monitor aging buckets (30 / 60 / 90+ days)
Denials Management:
- Analyze CGM denial reasons and determine next steps
- Resolve:
- Medical necessity denials
- Documentation-related denials
- Timely filing and processing issues
- Prepare claims for appeal or escalation when needed
- Collaborate with billing and appeals teams to resolve root causes
CGM-Specific Expertise:
- Understand Medicare CGM coverage requirements
- Identify patterns causing recurring denials
- Provide feedback to:
- Claim submission
- Documentation
- Billing leadership
Documentation & Tracking:
- Document all follow-up actions accurately in the billing system
- Maintain clean AR notes and status updates
- Support internal audits and payer reviews
Required Experience & Skills:
Applicants without Medicare DME AR experience will not be considered.
- 2+ years Medicare DME AR and denials experience
- Experience working CGM or other recurring DME supplies
- Strong understanding of Medicare denial codes and resolution paths
- Ability to communicate with Medicare MACs professionally
- Organized, persistent, and detail-oriented
Strongly Preferred:
- CGM billing experience (Dexcom G6 / G7)
- Experience with Niko Health
- Experience working with CGS or other Medicare MACs
- Prior experience supporting appeals or audit prep
What This Role Is Not:
- Not hospital AR
- Not commercial insurance collections
- Not Medicare Advantage-only
- Not entry-level billing
Key Performance Indicators (KPIs):
- Reduction in AR aging
- % of AR resolved within 30–60 days
- Dollars recovered per month
- Accuracy and quality of AR documentation
Compensation:
- Competitive salary based on experience
- Full-time, long-term role
- Opportunity to grow into senior AR or appeals-focused positions