Medical Denials & Billing Specialist

About the Company

Aptiva Medical is a growing DME provider making continuous glucose monitoring accessible to every patient who needs it. We partner with Abbott and Dexcom to serve Medicare and commercially insured patients nationwide. As we scale, we're investing in the people who protect our revenue and fix problems at the source.

About the Role

You'll spend most of your day in our denial queue — reading EOBs, working CARCs and payer rejections, filing appeals, calling payers, and chasing claims through payer portals until they're paid. You'll hit productivity and aging follow-up targets, and make sure every claim meets payer and Medicare documentation requirements before it goes back out.

The difference at Aptiva is what happens next. The patterns you spot become process improvements we actually implement. You'll partner with our RCM Supervisor to trace denials back to their source — intake, documentation, authorizations, contracting, or a workflow gap — and coordinate with those teams to fix the root cause so the denial doesn't happen again.

If you've ever looked at a denial queue and thought "the same five things keep showing up and nobody's fixing them," this is your role.

Responsibilities

• Work denied CGM claims; interpret CARCs, RARCs, and EOBs to find root cause
• Identify denial patterns by payer and reason code, then recommend upstream fixes
• Partner with Intake, Sales, Documentation, and Billing to reduce repeat denials
• Serve as the in-house expert on Medicare CGM coverage, LCDs, and payer nuance
• Support appeals and escalations with a prevention mindset
• Help build the SOPs and best practices our growing RCM operation runs on

Qualifications

• 3+ years in DME or CGM billing, denials, or reimbursement
• Strong knowledge of Medicare CGM coverage, documentation requirements, and applicable LCDs
• Working knowledge of CGM HCPCS codes (A4239, E2103, A9276, A9277, A9278)
• Proven ability to interpret CARCs/RARCs and resolve, not just reprocess, denials
• You think in patterns, not in single claims
• Strong written and verbal communication

Preferred

• Dexcom or FreeStyle Libre experience
• Exposure to Waystar or HDMS
• Comfort with Excel pivot tables for denial trend analysis
• Specific examples of finding the root cause of a denial pattern and seeing the fix through

Why Aptiva

• Real influence. Your insights from the denial queue go directly to RCM leadership and shape how we fix problems upstream
• A tight-knit onsite RCM team in Fort Lauderdale
• The chance to shape infrastructure and SOPs as we scale
• Competitive compensation based on your experience, skills, and demonstrated impact

Aptiva Medical is an Equal Opportunity Employer. Reasonable accommodations available upon request.