RCM Team Lead - Pharmacy & Infusion

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.

The RCM Team Lead is responsible for staff’s financial results of all of the insurance companies assigned to Brightree home infusion/pharmacy customers.  In addition, this role is, responsible for assisting Director in creating SOPs for the team to follow, assisting Director in creating 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, vendors, and internal teams on those procedures.  Responsible for training, monitoring quantity and quality assurance of work performed by internal team members.

Let's talk about Responsibilities:

• Understanding all general rules, guidelines, and methods to get paid from their staff’s assigned payers and the ability to back up/fill in for staff when necessary

• Responsible for the financial results of each Brightree RCM customer by ensuring accuracy of their team that results in:

  • Streamlining processes that will Reduce adjustments and write offs

  • Ensure that the billing methodology for each payer is documented and set-up throughout the Brightree system to realize maximum reimbursement

  • Propose and implement changes and updates to the configuration in areas such as:

    • Price tables

    • Pharmacy Contacts

    • Insurance Settings

    • Therapy and per diems

    • Modules adoption

    • Additional Services

  • Identifying areas of opportunities to better streamline internal or external processes:

    • By making suggestions for system enhancements to the Brightree System

    • Or process improvements to increase efficiency and accuracy

• Prepares and submits reports to Director as needed including but not limited to:

  • Quality Assurance Reporting

  • Denial Analyst Reporting

  • Service Level Agreement Reporting

  • Productivity and benchmark results

  • Monthly financial reporting

  • Other key reporting as identified by the Director or Brightree RCM Customer

• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals

• Maintains patient confidentiality and function within the guidelines of HIPAA

• Training new employees on all Brightree RCM Policies & Procedures

• Learning and documenting the billing methodology for new payer assignments for existing or new RCM accounts

• Other tasks and responsibilities as assigned.

Let's talk about Qualifications and Experience:

• High school diploma required.

• Minimum of 2 years of home infusion billing or 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

• Minimum of 2 years of Supervisory experience preferably in home infusion

• 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

• 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 bene