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:

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