Senior HME RCM Specialist
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Job Description
Senior HME RCM Specialist managing HME medical billing, claims, and collections for Prochant. Mentoring reimbursement specialists and improving quality, cash flow, and client satisfaction.
Responsibilities:
- 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
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