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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
In this role, you are responsible for high level DME / HME claim review & resolution. 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)
Requirements
- High School diploma or GED
- 2+ years DME / HME billing & collections experience
- California Insurance experience preferred
- Knowledge of one of the following DME / HME billing systems: Brightree, TIMS, HDMS, Bonafide, or CPR+
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
Prochant Charlotte, North Carolina, USA Office
14120 Ballantyne Corporate Pl, Suite 550, Charlotte, North Carolina, United States, 28277
What you need to know about the Charlotte Tech Scene
Ranked among the hottest tech cities in 2024 by CompTIA, Charlotte is quickly cementing its place as a major U.S. tech hub. Home to more than 90,000 tech workers, the city’s ecosystem is primed for continued growth, fueled by billions in annual funding from heavyweights like Microsoft and RevTech Labs, which has created thousands of fintech jobs and made the city a go-to for tech pros looking for their next big opportunity.
Key Facts About Charlotte Tech
- Number of Tech Workers: 90,859; 6.5% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Lowe’s, Bank of America, TIAA, Microsoft, Honeywell
- Key Industries: Fintech, artificial intelligence, cybersecurity, cloud computing, e-commerce
- Funding Landscape: $3.1 billion in venture capital funding in 2024 (CED)
- Notable Investors: Microsoft, Google, Falfurrias Management Partners, RevTech Labs Foundation
- Research Centers and Universities: University of North Carolina at Charlotte, Northeastern University, North Carolina Research Campus
