Revenue Cycle Manager, DME / CGM

Posted 2 days ago

med supply usDenver (CO)

Billing and Posting Clerks Medical, Dental, and Hospital Equipment and Supplies Merchant Wholesalers

SENIORITY

Senior

SALARY

$50,000 - $100,000 per year

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About the role

Accounts Receivable Manager Med Supply US is a Medicare-enrolled, ACHC-accredited mail-order DMEPOS supplier based in Hollywood, Florida. We ship continuous glucose monitors and supplies to thousands of Medicare patients in all 50 states. Billing runs in-house on NikoHealth, integrated with Zoho CRM, with Change Healthcare as the clearinghouse. We have a billing team in place. What we don't have is the person who owns the number. Accounts receivable, start to finish. You are accountable for cash collected, AR over 90 days, denial rate, and the rejection count, and you'll report those to the CEO weekly. Find out why claims aren't paying, payer by payer, fix the cause, and rework the batch. Not one claim at a time. Decide, with evidence, whether a patient's insurance will actually pay before we keep shipping. A payer rep's opinion is not evidence. Medicare CGM claims under LCD L33822: modifiers, same or similar, documentation requirements, and what the DME MACs actually pay on. Medicare crossover secondaries: dual eligibles, QMB, state Medicaid fee schedules, which states pay and which need pricing requests or appeals. Commercial and Medicare Advantage plans: DME versus pharmacy benefit carve-outs for CGM, out-of-network benefits, payer enrollment and EDI setup. Payer setup and rejection cleanup in NikoHealth and Change Healthcare, including print/paper payers. Write the follow-up process, run a single work queue, and make sure the billing team works it. You'll manage a small remote team, some offshore. Audits and overpayments: TPE, ADRs, recoupments.

Must have:

5+ years in DME billing and AR, with at least 2 years running it, not just working it. Physician, hospital, or behavioral health billing does not count.
Direct experience with Medicare DMEPOS claims: DME MAC jurisdictions, KX/GA/CG modifiers, same or similar, LCD documentation.
Experience with Medicare/Medicaid crossover claims and dual-eligible secondaries.
You've taken over a messy AR before and can walk us through exactly what you did in the first 30 days and what the aging looked like at 90.You can explain the difference between a clearinghouse rejection and a payer denial and which one has timely filing running on it, without looking it up.
US-based, remote, working Eastern hours.
Strong plus:
NikoHealth experience. This moves you to the top of the list.
CGM or diabetes supply billing specifically.
Change Healthcare, Availity, Noridian and CGS portals.
Experience managing offshore billing staff.
Medicaid enrollment across multiple states.
What this is not:
This is not a biller role and not a role for someone who needs a supervisor to tell them what to work on. The CEO built this billing stack himself and currently answers the team's questions. The point of this hire is that he stops.

Pay: $50,000 to $100,000 base, plus a performance bonus tied to cash collected and AR over 90. Full time, W-2 or 1099, your choice. Email your resume to [email] with answers to these three questions in the body. Applications without them won't be reviewed. We have 80 unpaid Blue Cross claims in NikoHealth. Walk us through, step by step, how you'd find out why and get them paid. A patient has Medicare primary and Medicaid secondary. Medicare paid, Medicaid paid $0. What are the possible reasons and what do you do for each? Which billing systems and clearinghouses have you personally worked in, and for how long?

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