Aptiva Medical is a durable medical equipment (DME) provider focused on making continuous glucose monitoring (CGM) accessible to patients nationwide, partnering with Abbott and Dexcom.
The CGM Denials & Revenue Integrity Specialist is responsible for analyzing denied CGM claims across Medicare and Commercial payers, interpreting CARCs, RARCs, and EOBs to identify root causes of denials. The specialist partners cross-functionally to recommend and implement upstream process improvements to prevent denials.
Collaborates with Intake, Sales, Documentation, and Billing teams to reduce repeat denials. Acts as a subject-matter expert on Medicare CGM coverage requirements and payer-specific guidelines. Supports appeals and escalations with an emphasis on learning and prevention. Contributes to standard operating procedures and best practices for denial management. Keeps up-to-date with Medicare LCDs, payer policies, HCPCS code updates, and CGM reimbursement changes.
- Minimum of 3 years experience in DME or CGM billing, denials, or reimbursement.
- Strong knowledge of Medicare CGM coverage and documentation requirements.
- Familiarity with CGM-related HCPCS codes (A4239, E2103, A9276, A9277, A9278) and Medicare LCDs.
- Experience interpreting EOBs/remittance advice and CARCs/RARCs.
- Proven ability to analyze and resolve claim denials effectively.
- Strong written and verbal communication skills.
Preferred:
- Direct experience with CGM products such as Dexcom and FreeStyle Libre.
- Knowledge of billing/clearinghouse platforms like Waystar or HDMS.
- Experience with denial analytics tools such as Excel pivot tables or Power BI.
- Demonstrated success in reducing denial rates or improving revenue outcomes.
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Location
Florida, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago