
Experienced healthcare professional with a strong background in Orthotics and Prosthetics (O&P) and Durable Medical Equipment (DME). Skilled in insurance verification, claims processing, coding review, and denial follow-up. Knowledgeable in Medicare and commercial payer guidelines, including HCPCS and ICD-10 coding. Recognized for attention to detail, problem-solving, and improving billing accuracy to support timely reimbursement. Proven ability to manage multiple responsibilities while supporting both clinical and administrative operations.
● Review patient medical records, physician orders, and documentation for accuracy prior to billing
● Enter and submit orthotic and prosthetic claims to Medicare and commercial insurance carriers
● Assign and review HCPCS and ICD-10 codes to ensure appropriate billing
● Verify patient demographic data, insurance coverage, and eligibility
● Identify and correct claim errors, rejections, and discrepancies through payer portals
● Follow up on unpaid or denied claims and assist with appeals when necessary
● Ensure all required documentation is obtained and meets payer guidelines
● Maintain compliance with Medicare policies, LCDs, and insurance requirements
● Communicate with insurance companies and internal teams to resolve billing issues
● Maintain patient confidentiality in compliance with HIPAA
● Stay current with changes in billing codes, payer policies, and medical terminology
● Oversee daily operations of a facility specializing in orthotic and prosthetic devices
● Ensure compliance with healthcare regulations and maintain quality standards
● Supervise staff including orthotists, prosthetists, and technicians
● Coordinate scheduling, inventory management, and procurement processes
● Ensure documentation is complete and supports billing and reimbursement requirements
● Implement process improvements to increase efficiency and workflow accuracy
● Address patient concerns and maintain accurate records to support patient care and operations
● Verify insurance coverage, eligibility, and benefits for O&P and DME services
● Obtain prior authorizations within required timeframes
● Maintain accurate patient information and ensure proper documentation for billing
● Collaborate with medical teams to gather necessary clinical documentation
● Ensure submissions meet payer requirements and guidelines
● Manage inventory, including ordering supplies and tracking incoming/outgoing items
● Maintain organization to support timely delivery of patient equipment
● Educate patients and internal teams on products and services
● Schedule patient appointments for fittings and deliveries
● Verify insurance coverage and explain copays and deductibles
● Obtain prior authorizations via phone, fax, and online portals
● Maintain patient records and support front office operations
● Manage daily deposits and ensure accurate cash drawer balances
● Process payments and maintain financial records
● Schedule service appointments and coordinate rental vehicle logistics
● File and maintain organized customer documentation
● Handle payments from warranty companies and assist with financial closing procedures
● Oversee loaner vehicle program and ensure timely returns
● Size and fit durable medical equipment including orthotics and bracing devices
● Educate patients on proper use and care of equipment
● Conduct hospital visits and assist with patient needs
● Maintain clean and organized clinical areas
● Restock equipment and prepare instruments for patient use
● Manage daily deposits and ensure accurate cash drawer balances
● Process payments and maintain financial records
● Schedule service appointments and coordinate rental vehicle logistics
● File and maintain organized customer documentation
● Handle payments from warranty companies and assist with financial closing procedures
● Oversee loaner vehicle program and ensure timely returns
● Effective Communication
● Organization & Multitasking
● Problem-Solving
● Customer Service
● Medical Knowledge
● Technical Proficiency
● Regulatory Knowledge
● Claim Submission
● Insurance Verification
● Denials & Appeals
● Attention to Detail
● Documentation Review
● Verbal and Written Communication
● HIPAA Compliance
● Microsoft Office
● HCPCS & ICD-10 Knowledge
● Insurance Policies & Coverage Criteria