RCM Pricing and Payor Coordinator

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 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.

Let's talk about Responsibilities:

Price Table Management: 

• 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. 

Support and Communication: 

• 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 and Analysis: 

• Research insurance billing requirements and fee schedules. 

• Perform price table analysis as needed. 

Compliance and Quality Assurance: 

• 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. 

SOP Management: 

• Update Department SOPs, ensuring compliance, best practices, proper format, and appropriate links before publishing. 

Customer Concerns: 

• 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. 

Mentorship: 

• Serve as an SME/Mentor to teammates, assisting with education and training. 

Let's talk about Experience and Qualifications:

• 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.