Senior HME RCM Specialist

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

📋 Description

• Provide strategic leadership, quality assurance, and advanced knowledge in billing and collections within Prochant’s HME Division.

• Manage the timely and accurate processing of HME reimbursement claims, encompassing intake, eligibility/prior authorization, qualification, confirmation, billing, denials, accounts receivable, held/stopped release, and cash posting.

• Liaise with health plans to guarantee the submission of clean claims.

• Act as a versatile resource for emerging challenges, escalated client issues, process disruptions, and operational priorities.

• Employ billing software, payer portals, and data reporting tools to oversee outstanding accounts receivable and optimize cash collections.

• Mentor and train global reimbursement specialists on best practices and strategies for resolving billing challenges.

• Serve as a liaison between reimbursement specialists and management.

• Execute quality assurance checks for claim accuracy, compliance, efficiency, and adherence to client-required protocols.

• Identify and address or escalate roadblocks impacting clients or Prochant.

• Foster professional relationships with the Reimbursement Manager and address inquiries clearly and professionally.

• Prioritize tasks, adapt to evolving priorities, and maintain focus on deadlines and outcomes.

• Collaborate effectively with offshore teams.

• Assist with special projects, process improvement initiatives, and cross-functional efforts.

⛳️ Requirements

• High School diploma or equivalent is required.

• At least 2 years of experience in home HME billing and collections.

• Experience with Brightree, CPR+, CareTend, or WeInfuse software is preferred.

• Strong written and verbal communication skills, with the ability to mentor and train others.

• Proven initiative and problem-solving capabilities.

• In-depth knowledge and experience in billing and collecting major medical claims for home HME, ambulatory HME, and/or specialty pharmacy.

• Ability to demonstrate a comprehensive understanding of CMS 1500 and 837 claim formatting and billing processes.

🏝️ Benefits

• Health Insurance

• Gap Insurance

• Dental Insurance

• Vision Insurance

• Short Term/Long Term Disability (company paid)

• Term Life Insurance (company paid; employee can elect additional)

• Disability Income

• Level Term Life

• Accident Insurance

• Critical Illness Insurance

• Floating holidays and paid time off

• 401K with Company match

• Family Teledoc Plan (Company Paid)

• Fortune 500 level benefits package