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The RCM Pricing and Payor Coordinator is responsible for analyzing, maintaining, and optimizing Brightree RCM customer pricing structures. This role requires analytical skills, deep HME/DME billing knowledge, and the ability to interpret payor fee schedules, identify pricing discrepancies, and troubleshoot billing issues that impact reimbursements. The ideal candidate has hands-on Medicare and commercial payor experience, understands reimbursement methodologies, and can proactively identify and resolve pricing gaps that affect revenue cycle performance. This role goes beyond data entry, requiring critical thinking, problem-solving, and strong collaboration with internal teams and external customers.
Job Responsibility:
Analyse and process price table updates and requests for RCM customers
Ensure accuracy and integrity of existing price tables
Create new price table requests for new RCM customer contracts
Maintain and update price tables for Brightree RCM customers
Manage price table requests through SmartSheet & Salesforce
Assist the RCM team with pricing and billing questions
Communicate with stakeholders and RCM customers on price table requests/updates
Provide best practice direction on common price table issues
Prepare and submit client reports as needed
Research insurance billing requirements and fee schedules
Perform price table analysis as needed
Understand general rules, guidelines, and methods for payor payments
Follow policies, procedures, and systems for quality assurance as directed by Medicare, Medicaid, and private insurance
Ensure adherence to objectives, operating policies, procedures, and strategic action plans
Update Department SOPs, ensuring compliance, best practices, proper format, and appropriate links before publishing
Lead intake of customer concerns and provide recommendations to the manager for resolution
Manage escalations and act as the Brightree software SME for Price Tables, communicating directly with customer executives, directors, and management staff on price table requests/updates
Serve as an SME/Mentor to teammates, assisting with education and training
Requirements:
High School degree required, college coursework a plus
Minimum of 2-3 years of DME/HME billing with preferred experience in working AR follow up and denials
Knowledge of Medicare payment rules
Minimum of 1 year in a customer support environment
Computer literate and proficient with Microsoft Office Suite (Outlook, Word, and Excel)
Knowledgeable in federal and state laws and requirements relating to healthcare management and billing for DME/HME
Excellent attention to detail and ability to investigate and troubleshoot price table issues, finding workarounds as needed
Strong ethics and a high level of personal and professional integrity
Exceptional organizational skills with the ability to multitask within multiple client databases
Quick learner, pleasant, and dedicated to providing a positive customer experience
Ability to work in a fast-paced, challenging environment with minimal supervision
Strong interpersonal, communication, and customer service skills with the ability to resolve challenging issues promptly
Experience using the following applications/software: Teams, SharePoint, SmartSheet, Salesforce
Advanced proficiency in Microsoft Excel
Brightree Price Table knowledge/experience
What we offer:
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