RCM Specialist

• Manage and oversee the revenue cycle process for Home Infusion and Pharmacy services provided by our customers, ensuring timely and accurate billing, claims submission and follow up.  

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

• Responsible for the financial results for their assigned payers, for Brightree customers by ensuring accuracy. This includes but is not limited to; 

• Reducing credit adjustments and write-offs by billing accurate net revenue. 

• Ensuring the billing methodology for each payer is documented and set up properly in the Brightree system to realize maximum reimbursement.  

• Propose changes and updates to the configuration of the customer’s Brightree system (examples: Price Tables, Pharmacy Contracts, Insurance Settings) 

• Identifying areas of opportunity to better streamline RCM processes (examples: suggest system enhancements or process improvements which would increase efficiency).  

• Maintain patient confidentiality and function within the guidelines of HIPAA.  

• 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, cash posting, and compliance, to ensure accurate and compliant claim submissions. 

• Stay up to date with industry and payer 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 (as designated by management if applicable) 

• Other tasks and responsibilities as assigned.  

 Let’s talk about Qualifications and Experience 
 
Required: 

• Minimum 2 years of hands-on experience in revenue cycle management within the DME/HME specialty home infusion experience is a plus. 

• Minimum of 2 years' experience working in and maintaining HIPAA standards.  

• Understanding all general rules, guidelines, and methods for billing and/or collection activity that result in payment from the insurance companies for which they are assigned.  

• Highly skilled in using computers & Microsoft products (Excel and Word) is required. 

• Highly motivated in billing, claims, denials, and document management to work with our internal and external customers on the phone or via software applications. 

• Math aptitude 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 team clients, and payers.  

• Detail-oriented with exceptional analytical and problem-solving skills as well as a high level of attention to detail. Ability to work independently and in a team-oriented environment. Self-starter, results driven, high energy.  

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

• Proven track record of working towards and exceeding metrics strongly preferred. 

Preferred: 

• Bachelor’s degree. 

• 2 years of related experience. Home Infusion Preferred