Senior HME RCM Specialist

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

📋 Description

• The Senior HME RCM Specialist plays a pivotal role in providing thought leadership, quality assurance, and advanced billing and collections expertise within Prochant’s HME Division. This position not only oversees reimbursement tasks but also serves as a mentor and trainer for other global reimbursement specialists, fostering their professional development. Acting as a liaison between the reimbursement specialists and the Reimbursement Manager, they help optimize operations, address challenges, and support complex projects. This role is essential in nurturing a collaborative, high-performing team environment while aligning with the division’s strategic growth goals. Responsibilities encompass, but are not limited to:

• Overseeing the timely and accurate processing of HME reimbursement claims, ensuring clean claim submission and following up with health plans. Responsibilities may include intake, eligibility/prior authorization, qualification, confirmation, billing, denials, accounts receivable, held/stopped release, or cash posting.

• Serving as a flexible and highly adaptable resource across the HME team, stepping in to tackle emerging challenges, escalated client issues, process breakdowns, and evolving operational priorities.

• Utilizing billing software, payer portals, and data reporting tools to manage outstanding accounts receivable and enhance cash collections.

• Mentoring and training global reimbursement specialists, offering guidance on best practices and strategies for overcoming billing challenges.

• Acting as a conduit between team members and management, addressing escalated client concerns and allowing managers to focus on their core responsibilities.

• Conducting quality assurance checks to ensure claim accuracy, compliance, and efficiency in reimbursement processes or adherence to client-required protocols.

• Proactively identifying potential obstacles affecting clients or Prochant, and escalates or resolves them promptly.

• Maintaining strong relationships with the Reimbursement Manager, responding to inquiries with professionalism and clarity.

• Prioritizing responsibilities, managing workload effectively, and adapting to changing priorities while maintaining focus on deadlines and outcomes.

• Collaborating with offshore teams and contributing to initiatives that support organizational needs.

• Supporting special projects, process improvement initiatives, and cross-functional efforts that enhance operational excellence and client satisfaction.

• **Who Will Be Successful in This Role**

• The ideal candidate thrives in variety and is energized by solving complex issues. This is not a role characterized by repetitive tasks, as each day presents unique challenges. Success in this position requires an individual who can quickly assess situations, shift priorities as necessary, and confidently tackle new challenges as they arise.

• The right person will:

• Thrive in a fast-paced, ever-evolving environment.

• Enjoy being the go-to resource for challenging reimbursement and client issues.

• Be comfortable transitioning between projects, escalations, mentoring, and operational support throughout the day.

• Take the initiative to identify and address issues before they escalate into larger problems.

• View shifting priorities as opportunities rather than disruptions.

• Bring a solutions-oriented mindset and a willingness to provide support wherever needed.

⛳️ Requirements

• High School diploma or equivalent required.

• A minimum of 2 years of experience in home HME billing and collections.

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

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

• Demonstrated 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 clear understanding of CMS 1500 and 837 claim formatting and billing processes.

🏝️ Benefits

• Prochant offers some of the most competitive benefits in the industry! We prioritize the well-being of our employees, providing a Fortune 500-level benefits package.

• Excellent benefits package including:

• Health Insurance

• Gap Insurance

• Dental Insurance

• Vision Insurance

• Short Term/Long Term Disability (company paid)

• Term Life Insurance (company paid, with options for additional coverage)

• 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)