Quality Assurance Specialist

Brightree is a wholly owned subsidiary of ResMed (NYSE: RMD, ASX: RMD).

When you work at Brightree, it’s more than just a job. You’ll be part of a team that’s driving innovation and leading the way in cloud-based patient management software. 

The technology allows us to provide the tools for better outcomes but at our heart, we’re really about people. We strive to positively impact our customers’ businesses and the lives of patients every single day.

A Brightree Quality Assurance Specialist is the front line in assuring the success of the entire Billing Center. Our QA Specialists are responsible for trending analysis, implementation, and education for our partners and clients.

Let’s talk about Responsibilities

• Required to learn multiple insurance guidelines and specific durable medical equipment requirements for Medicare, National Commercial and Medicaid plans, including HMO replacement plans. 

• Responsible for ensuring quality confirmation for optimal claim processing as well as analyzing sales order trending issues (KPI)

• Immediate escalation of quality related issues 

• Required to analyze medical documentation to qualify the patient for the equipment, supplies, or testing being ordered by provider specification 

•  Conducts random audit on all transactions processed by our internal teams and communicate and track trended results 

• Required to escalate quality related issues, errors, trainings, and support to our Internal & External Teams in a timely manner 

• Regularly creates & modifies Standard Operating Procedures (SOP) & Workflow system for specific payor and/or client rules

• Implements and adhere to policies, procedures, and systems within the Brightree systems 

• Ensures accuracy to optimize reimbursement while adhering to company policies while maintaining compliance. 

• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals to improve Revenue Cycle practices and increase revenue 

• Must be detail oriented and complete tasks in a timely manner 

• Other tasks and responsibilities as assigned 

Let’s talk about Qualifications and Experience  

Required

• High School degree required, college coursework a plus 

• Knowledge of durable medical equipment and insurance billing 

• Strong communication skills, ability to multi-task and conduct multiple levels of service to clients from basic to in depth while maintaining task completion and timely deadlines 

• Capable user of Microsoft Office products including Outlook, Excel, Word and PowerPoint 

• Capable user of remote collaboration tools: Zoom, Go-To Meeting, Microsoft Teams and SharePoint 

• Equivalent combination of education and experience will be considered 

Preferred

• Knowledge of Power Mobility, Sleep Studies, and CGMs. 

• Brightree software knowledge 

We are shaping the future at ResMed, and we recognize the need to build on and broaden our existing skills and continue to attract and retain the world’s best talent. We work hard to offer holistic benefits packages, provide flexible work arrangements, cultivate a workforce culture that allows employees to grow personally and professionally, and deliver competitive salaries to our team members. Employees scheduled to work 30 or more hours per week are eligible for benefits. This position qualifies for the following benefits package: comprehensive medical, vision, dental, and life, AD&D, short-term and long-term disability insurance, sleep care management, Health Savings Account (HSA), Flexible Spending Account (FSA), commuter benefits, 401(k), Employee Stock Purchase Plan (ESPP), Employee Assistance Program (EAP), and tuition assistance. Employees accrue fifteen days Paid Time Off (PTO) in their first year of employment, receive 11 paid holidays plus 3 floating days and are eligible for 14 weeks of primary caregiver or two weeks of secondary caregiver leave when welcoming new family members.
 
Individual pay decisions are based on a variety of factors, such as the candidate’s geographic work location, relevant qualifications, work experience, and skills. At ResMed, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current base pay for this position is: $16.48 - $20.60 USD hourly.

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.