RCM Specialist – Quality

Let’s talk about Responsibilities

• Manage and oversee the revenue cycle process for DME/HME services, ensuring timely and accurate billing, claims submission, and payment posting.

• Conduct thorough AR follow-up and denial management, working closely with the billing teams to resolve outstanding issues and minimize AR aging.

• Maintain a comprehensive understanding of US payer policies, rules, and regulations, with a particular focus on Medicare, Medicaid, and other relevant insurance plans.

• Collaborate with internal teams, including billing, coding, and compliance, to ensure accurate and compliant claim submissions.

• Stay up-to-date with industry changes, including coding and billing requirements, reimbursement guidelines, and regulatory updates.

• Assist with internal and external audits, ensuring compliance with regulatory and contractual obligations.

• Participate in quality control activities, conducting audits and providing recommendations for process improvements.

Let’s talk about Qualifications and Experience

Required:

• 2 years of hands-on experience in revenue cycle management within the DME/HME specialty.

• Strong knowledge and experience with AR follow-up and denial management processes.

• In-depth understanding of US payer management, including Medicare, Medicaid, and commercial insurance.

• Excellent written and verbal communication skills, with the ability to effectively communicate with internal teams, clients, and payers.

• Detail-oriented with exceptional analytical and problem-solving skills.

• Previous experience as an auditor and quality control specialist is preferred, but not mandatory.

• Ability to work independently and in a team-oriented environment.

• Strong organizational skills with the ability to prioritize tasks and meet deadlines.

• Up-to-date knowledge of coding and billing regulations, reimbursement guidelines, and industry trends.

Preferred:

• Bachelor’s degree.

• 2 years of related experience.

• Proficiency in using Brightree software is highly preferred.

• Developing professional expertise, applies company policies and procedures to resolve a variety of issues.

Joining us is more than saying “yes” to making the world a healthier place. It’s discovering a career that’s challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individual expression in the workplace and thrive on the innovative ideas this generates. If this sounds like the workplace for you, apply now!We commit to respond to every applicant.

Originally posted on Himalayas