The DME Reimbursement Specialist manages billing, claims generation, denial management, and cash posting in the healthcare billing service sector, ensuring quality assurance and compliance.
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
- 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
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