Lead HME RCM Specialist

Prochant US

About The Position

The Lead HME RCM Specialist is responsible for providing thought leadership, quality assurance, and advanced expertise in billing and collections within Prochant’s HME Division. In addition to managing reimbursement tasks, the lead HME RCM specialist acts as a mentor and trainer for other global reimbursement specialists, supporting their professional growth and development. Serving as a liaison between reimbursement specialists and the Reimbursement Manager, they help streamline operations, resolve challenges, and assist with complex projects. This position is crucial in fostering a collaborative, high-performing team environment while supporting the division’s strategic growth objectives.

Requirements

High School diploma or equivalent required.
Minimum 2 years of experience in home HME billing and collections.
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.

Nice To Haves

Experience using Brightree, CPR+, CareTend, or WeInfuse software preferred.

Responsibilities

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