RCM 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.

RCM DME Payor Analyst is responsible for financial results of the insurance companies and Brightree customers.  In addition, this role is, responsible for identifying and following policies, procedures and systems for quality assurance as directed by Medicare, Medicaid and Private insurance. Assist in creating and revising our standard operating procedures and educate our partners, worldwide vendors, and internal teams on those procedures. Responsible for quality assurance of work performed by internal team members.

Key accountabilities and decision ownership:

• Understanding all general rules, guidelines, and methods to get optimal reimbursement from the insurance companies for which they are assigned
• Responsible for resolving and routing incoming salesforce cases from customers
• Responsible for the financial results of the insurance companies and Brightree customers by ensuring accuracy:
  • Reducing Credit Adjustments and Write Off’s
  • Ensure that the billing methodology for each payer is documented and set-up throughout the Brightree system to realize maximum reimbursement
  • Propose changes and updates to the configuration of the customers Brightree system including but not limited to
    • Price tables
    • Insurance Settings
    • Additional Services
  • Identifying areas of opportunities to better streamline internal or external processes
• Continuously improve current business and system processes by creating, redefining, and maintaining standard operating procedures (SOPs) to ensure maximum efficiency in business and system processes; seek input on improved strategies and processes to help achieve goals; implement new processes and system practices to achieve the goal of reducing time to market for new products while maintaining the highest quality products in the market.
• Prepares and submits reports to team lead as needed including but not limited to:
  • Quality Assurance Reporting
  • Denial Analyst Reporting
  • Service Level Agreement Reporting
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals
• Collaborates with worldwide resources to ensure effective knowledge, information sharing, and quick resolution of service performance issues.
• Maintains patient confidentiality and function within the guidelines of HIPAA
• Other tasks and responsibilities as assigned

Skills, experience, technical/professional qualifications:

Must have:

• High school diploma required; equivalent combination of education and experience will be considered
• Minimum of 2 years of DME Billing and accounts receivable experience required
• Minimum of 2 years of experience working in & maintaining HIPAA standards
• 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
• Strong problem-solving skills focused on resolving complex home infusion claims
• An effective communicator with strong oral, written and persuasive skills and capability to deal with people at all levels in the organization and the public in a professional manner
• Exceptional organizational skills with a high level of attention to detail and the ability to multitask
• Self-starter, results driven, highly motivated, high energy
• Proven track record of working towards and exceeding metrics strongly preferred

Preferred:

• A 2-year degree or additional college coursework
• 5 years of experience in a healthcare reimbursement role

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 range for this position is: $16.48 - $24.72/hr

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.