Claims Manager-DMEPOS Position Available In Allegheny, Pennsylvania

Claims Manager-DMEPOS 2.4 2.4 out of 5 stars 301 Corbet Street, Tarentum, PA 15084 Blackburn’s is a trusted and established provider of DMEPOS equipment and supplies. Dedicated to enhancing the quality of life for our patients, we deliver compassionate service, reliable products, and third-party Claims. Our reputation for excellence has made us a key partner for both healthcare providers and the communities we serve. The Claims Manager leads the daily operations of the claims department, ensuring timely, accurate, and compliant claims across all payer types. This key leadership role is responsible for optimizing Claims workflows, mentoring team members, and collaborating across departments to improve revenue cycle performance. The ideal candidate is a strategic thinker and hands-on leader with deep experience in DMEPOS claims, payer guidelines, and medical reimbursement. reimbursement. Key Responsibilities Lead, mentor, and supervise the Claims team to ensure accurate claim generation and timely submission and denial management across all payers. Manage daily Claims operations, ensuring productivity, efficiency, and compliance with industry regulations. Serve as the escalation point and subject matter expert for complex claims scenarios, denials, and payer policies. Ensure all Claims processed align with Medicare, Medicaid, and commercial insurance requirements, including HCPCS, diagnosis codes, and modifiers. Monitor accounts receivable and aging reports, driving resolutions on outstanding claims and identifying trends impacting reimbursement. Collaborate with internal and external systems, documentation, compliance, customer service, and leadership teams to support seamless end-to-end revenue cycle processes. Implement and monitor internal controls and standard operating procedures to ensure Claims accuracy and regulatory compliance. Provide regular performance feedback and training to Claims team members; foster a collaborative and high-performance culture. Support internal audits, external payer audits, and participate in the implementation or optimization of Claims software and tools. Drive continuous improvement initiatives focused on reducing claim errors, denial rates, and improving first-pass claim acceptance. Bachelor’s degree or High school diploma with a minimum of 5 years of medical Claims experience in a DMEPOS or healthcare center. At least 3 years of experience in a supervisory or management role within a Claims or revenue cycle function. Strong understanding of payer guidelines, medical coding (HCPCS, CPT), modifiers, and DME Claims regulations. Proficient in medical Claims software; experience with TIMS or similar platforms strongly preferred. Knowledge of Medicare, Medicaid, managed care, and commercial insurance claims processing. Excellent communication, leadership, and conflict resolution skills. Proven ability to manage priorities in a fast-paced, deadline-driven environment. Commitment to service excellence and patient-centered care.