DME Reimbursement Specialist
About The Position
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. In this role, you are responsible for consistent productions of intake, billing, collections, and cash posting. This includes Billing Review & Claims Generation, Exception Tasking, Follow Ups, Peer Coaching/Peer Support, Peer Quality Assurance (Audits), A/R & Denial Management, Documentation Review & Indexing, Patient and order generation (intake), Eligibility or benefit verification, Prior authorization submission, and 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
Nice To Haves
- Knowledge of one or more of the following additional DME / HME billing systems: Brightree, TIMS, Bonafide, or CPR+
- California Insurance experience
Responsibilities
- 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)
- Documentation Review & Indexing: Review of inbound scanned documentation, Analysis of documents and assignment to appropriate document classes (for follow up), Production log maintenance
- Patient and order generation (intake)
- Eligibility or benefit verification
- Prior authorization submission
- Cash Posting
Benefits
- Excellent benefits package
- 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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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
