DME Reimbursement SpecialistProchant US • US

DME Reimbursement Specialist

Prochant US • US

3 days ago

Job type

Full-time

Remote

Quick Apply

Job description

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

Mail

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

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Reimbursement Specialist • US

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