Senior HME RCM Specialist

🕒 Julho 30

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Prochant

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

🏥 Saúde

⚕️ Seguro de Saúde

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

A Prochant é uma empresa especializada em otimizar o gerenciamento do ciclo de receita (RCM) para o setor de cuidados domiciliares, incluindo equipamentos médicos domiciliares, infusão e cuidados de saúde domiciliares. Eles utilizam tecnologia inovadora e equipes especializadas para melhorar o desempenho financeiro e a eficiência de seus clientes. Os serviços da Prochant cobrem admissão, faturamento e cobrança, com ofertas de parcerias flexíveis para atender a diversas necessidades operacionais. Sua tecnologia proprietária Prochant Pulse inclui análises e gerenciamento de fluxo de trabalho impulsionado por IA para melhorar a tomada de decisões e a produtividade. Ao lidar com os processos de RCM, a Prochant permite que os clientes se concentrem mais no atendimento ao paciente e no sucesso operacional.

Descrição

• The Senior HME RCM Specialist is responsible for providing thought leadership, quality assurance, and advanced expertise in billing and collections within Prochant’s HME Division. In addition to managing reimbursement tasks, the senior HME RCM specialist acts as a mentor and trainer for other global reimbursement specialists, supporting their professional growth and development. Serving as a liaison between reimbursement specialists and the Reimbursement Manager, they help streamline operations, resolve challenges, and assist with complex projects. This position is crucial in fostering a collaborative, high-performing team environment while supporting the division’s strategic growth objectives. Responsibilities include but are not limited to: • - Overseeing timely and accurate processing of HME reimbursement claims, ensuring clean claim submission and follow-up with health plans. Work could be in intake, eligibility/prior authorization, qualification, confirmation, billing, denials, AR, held/stopped release, or cash posting. • - Serve as a flexible, highly adaptable resource across the HME team, stepping in to address emerging challenges, escalated client concerns, process breakdowns, and operational priorities as business needs evolve. • - Utilizing billing software, payer portals, and data reporting tools to manage outstanding A/R and enhance cash collections. • - Mentoring and training global reimbursement specialists, providing guidance on best practices and strategies for resolving billing challenges. • - Acting as a liaison between team members and management, assisting with escalated client concerns and freeing up manager time. • - Conducting quality assurance checks to ensure claim accuracy, compliance, and efficiency in reimbursement processes or compliance with client required protocols. • - Proactively identifying potential roadblocks affecting clients or Prochant, escalating or resolving them in a timely manner. • - Maintaining strong relationships with 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 participating in efforts to support organizational needs. • - Support special projects, process improvement initiatives, and cross-functional efforts that contribute to operational excellence and client satisfaction. • **Who Will Be Successful in This Role ** • The ideal candidate enjoys variety and is energized by solving complex problems. This is not a highly repetitive role where each day follows the same routine. Success in this position requires someone who can quickly assess situations, shift priorities when needed, and confidently tackle new challenges as they arise. • The right person will: • - Thrive in a fast-paced, ever-changing environment. • - Enjoy being the go-to resource for difficult reimbursement and client challenges. • - Be comfortable pivoting between projects, escalations, mentoring, and operational support throughout the day. • - Take initiative to identify and resolve issues before they become larger problems. • - View changing priorities as an opportunity rather than a disruption. • - Bring a solutions-oriented mindset and a willingness to step in wherever support is needed.

🎯 Requisitos

• - High School diploma or equivalent required. • - Minimum 2 years of experience in home HME billing and collections. • - Experience using Brightree, CPR+, CareTend, or WeInfuse software preferred. • - Strong written and verbal communication skills with an ability to mentor and train others. • - Demonstrated initiative and problem-solving ability • - Deep knowledge and experience 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 process.

🏖️ Benefícios

• Prochant offers some of the best benefits in the industry! We take great care of our employees. 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, 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)