Senior HME RCM Specialist

Responsibilities

• Oversee timely and accurate processing of HME reimbursement claims, ensuring clean claim submission and follow-up with health plans.
• Work in areas such as 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.
• Utilize billing software, payer portals, and data reporting tools to manage outstanding A/R and enhance cash collections.
• Mentor and train global reimbursement specialists, providing guidance on best practices and strategies for resolving billing challenges.
• Act as a liaison between team members and management, assisting with escalated client concerns and freeing up manager time.
• Conduct quality assurance checks to ensure claim accuracy, compliance, and efficiency in reimbursement processes or compliance with client required protocols.
• Proactively identify potential roadblocks affecting clients or Prochant, escalating or resolving them in a timely manner.
• Maintain strong relationships with Reimbursement Manager, responding to inquiries with professionalism and clarity.
• Prioritize responsibilities, manage workload effectively, and adapt to changing priorities while maintaining focus on deadlines and outcomes.
• Collaborate with offshore teams and participate in efforts to support organizational needs.
• Support special projects, process improvement initiatives, and cross-functional efforts that contribute to operational excellence and client satisfaction.

Qualifications

• 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.