DME Reimbursement Specialist

The DME Reimbursement Specialist is responsible for multiple areas that are key to success for Prochant, a billing service and process outsourcing company in the U.S. healthcare industry. The DME Reimbursement Specialist responsibilities include:

• Billing Review
• Claim Generation
• A/R & Denial Management
• Unaddressed Claim Management
• Stop/Held Revenue review
• Correspondence review and Indexing
• Reporting and reconciliation of all executable work tasks
• Escalations/tasking of work exceptions to appropriate parties
• Management of follow-ups
• Peer support/Peer coaching
• Quality Assurance
• Eligibility
• Prior Authorization
• Intake
• Cash posting

In this role, you are responsible for consistent productions of intake, billing, collections, and cash posting. This includes:

• Billing Review & Claims Generation
• Manage inbound queue of orders to be reviewed/claims to be generated
• Quality review prior to claim generation
• Claim generation within specified turnaround time
• Maintenance of downloads and production logs
• Exception Tasking
• Follow Ups
• Peer Coaching/Peer Support
• Peer Quality Assurance (Audits)
• A/R & Denial Management
• Denied claim review and analysis
• Denied claim resolution action including, but not limited to:
• Telephone claim status requests
• Telephone re-opening requests
• Medical documentation/Supporting documentation reviews
• Redeterminations and appeals
• Fax
• Mail
• Online
• Denied claim tasking to appropriate parties for follow up
• Authorization team (internal or external)
• Documentation team (internal or external)
• Peer Coaching/Peer Support
• Peer Quality Assurance (Audits)
• Documentation Review & Indexing
• Review of inbound scanned documentation
• Analysis of documents and assignment to appropriate document classes (for follow up)
• Production log maintenance
• Peer Coaching/Peer Support
• Peer Quality Assurance (Audits)
• Patient and order generation (intake)
• Eligibility or benefit verification
• Prior authorization submission
• Cash Posting

Requirements

• High School diploma or GED
• 2+ years DME / HME billing & collections experience
• Experience managing intake, billing, collections, and cash posting
• Knowledge of the HDMS billing system
• Willingness to undergo additional identity verification through ID.me
• Knowledge of one or more of the following additional DME / HME billing systems: Brightree, TIMS, Bonafide, or CPR+ preferred
• California Insurance experience preferred

Benefits

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)
• Full suite of CHUBB supplemental insurance plans including:
  • Disability Income
  • Level Term Life
  • Accident Insurance
  • Critical Illness Insurance
• Pre-Paid Legal
• FSA / HSA with eligible plans
• 401K with company match

• Floating holidays and paid time off

Originally posted on Himalayas