RCM Specialist – Quality, US Healthcare, DME/HME

This is a fully remote position, open to applicants in India.

📋 Description

• Oversee and manage the revenue cycle process for DME/HME services, ensuring timely and precise billing, claims submission, and payment posting.

• Perform comprehensive AR follow-up and denial management, collaborating closely with billing teams to address outstanding issues and reduce AR aging.

• Maintain an extensive understanding of US payer policies, regulations, and rules, particularly focusing on Medicare, Medicaid, and other pertinent insurance plans.

• Work in partnership with internal teams, such as billing, coding, and compliance, to guarantee accurate and compliant claim submissions.

• Keep abreast of industry changes, including updates to coding and billing requirements, reimbursement guidelines, and regulatory developments.

• Support internal and external audits, ensuring adherence to regulatory and contractual obligations.

• Engage in quality control initiatives, performing audits and offering recommendations for process enhancements.

⛳️ Requirements

• At least 2 years of direct experience in Revenue Cycle Management within the DME/HME sector.

• Strong expertise in AR follow-up and denial management processes.

• Comprehensive knowledge of US payer management, including Medicare, Medicaid, and commercial insurance.

• Exceptional written and verbal communication abilities, capable of effectively engaging with internal teams, clients, and payers.

• Detail-oriented with outstanding analytical and problem-solving capabilities.

• Previous experience as an auditor and quality control specialist is preferred, though not required.

• Ability to operate independently as well as within a team-oriented environment.

• Strong organizational skills to prioritize tasks and meet deadlines effectively.

• Current knowledge of coding and billing regulations, reimbursement guidelines, and industry trends.

• Preferred: Bachelor’s degree.

• 2 years of relevant experience.

• Proficiency in using Brightree software is highly preferred.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible work hours

• Paid time off

• Remote work options