Senior HME RCM Specialist

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

📋 Description

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

• Supervise 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.

• Follow up with health insurance plans to ensure seamless claim submissions.

• Act as a versatile resource to tackle emerging challenges, address escalated client issues, manage process breakdowns, and prioritize operational tasks.

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

• Mentor and guide global reimbursement specialists on best practices and resolution of billing challenges.

• Serve as a bridge between reimbursement specialists and management, assisting with client concerns that require escalation.

• Perform quality assurance checks to ensure claim accuracy, compliance, efficiency, and adherence to client protocols.

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

• Maintain robust relationships with the Reimbursement Manager and respond to inquiries with professionalism and clarity.

• Prioritize tasks, manage workload, and adapt to evolving priorities while achieving deadlines and outcomes.

• Collaborate with offshore teams and support organizational requirements.

• Assist with special projects, process improvement initiatives, and cross-functional efforts aimed at enhancing operational excellence and client satisfaction.

⛳️ Requirements

• High School diploma or equivalent is required.

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

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

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

• Proven initiative and strong problem-solving capabilities.

• Extensive 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

• 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