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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
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