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.

Let’s talk about Responsibilities

• 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  

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.