Senior HME RCM Specialist

🔥 15 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

👻 Ghost score 10%

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Prochant

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Prochant is a company specializing in optimizing revenue cycle management (RCM) for the home-based care sector, including home medical equipment, infusion, and home health care. They leverage innovative technology and expert teams to improve financial performance and efficiency for their clients. Prochant's services cover intake, billing, and collections with flexible partnership offerings to meet diverse operational needs. Their proprietary Prochant Pulse technology includes analytics and AI-driven workflow management for enhanced decision-making and productivity. By handling RCM processes, Prochant allows clients to focus more on patient care and operational success.

📋 Description

• Provide thought leadership, quality assurance, and advanced expertise in billing and collections within Prochant’s HME Division. • Oversee timely and accurate processing of HME reimbursement claims, including intake, eligibility/prior authorization, qualification, confirmation, billing, denials, accounts receivable, held/stopped release, or cash posting. • Follow up with health plans and ensure clean claim submission. • Serve as a flexible resource addressing emerging challenges, escalated client concerns, process breakdowns, and operational priorities. • Utilize billing software, payer portals, and data reporting tools to manage outstanding accounts receivable and enhance cash collections. • Mentor and train global reimbursement specialists on best practices and billing challenge resolution. • Act as liaison between reimbursement specialists and management, assisting with escalated client concerns. • Conduct quality assurance checks for claim accuracy, compliance, efficiency, and client-required protocols. • Identify and resolve or escalate roadblocks affecting clients or Prochant. • Maintain strong relationships with the Reimbursement Manager and respond to inquiries professionally and clearly. • Prioritize responsibilities, manage workload, and adapt to changing priorities while meeting deadlines and outcomes. • Collaborate with offshore teams and support organizational needs. • Support special projects, process improvement initiatives, and cross-functional efforts contributing to operational excellence and client satisfaction.

🎯 Requirements

• 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.

🏖️ 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