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 Enrollment Lead is responsible for the enrollment process for insurance payers with multiple clearinghouses and optimizing the efficiency of enrollment operations.
This role involves collaborating with internal teams and vendor partners and leading initiatives to enhance enrollment strategies.The Enrollment Lead is a subject matter expert on the payer enrollment processes and requirements for commercial insurance companies, CMS Federal and State Guidelines related to enrollment and re-enrollment policies. It is a hands-on, working Lead role.
Let’s talk about Responsibilities
Enrollment Management
- Lead the payer enrollment process, ensuring timely and accurate submissions of applications and required documentation.
- Communicate with healthcare providers to gather necessary documentation and information for enrollment or re-enrollment processes.
- Process incoming Enrollment requests for Commercial/Government insurance plans for new and existing clients serving as liaison between the client and the clearinghouse.
- Coordinate with clearinghouses to resolve any issues or discrepancies that arise during the enrollment process.
Process Improvement
- Identify and implement best practices to streamline enrollment processes with multiple clearing houses and reduce turnaround times.
Data Analysis
- Analyze enrollment data to identify trends, challenges, and opportunities and inform decision-making.
Stakeholder Collaboration
- Work closely with internal teams and external stakeholders (e.g., payers) to resolve issues and improve enrollment outcomes.
Documentation Maintenance
- Ensure accurate maintenance of enrollment documentation.
Case Management
- Complete deactivations of provider numbers, effective dates, NPI-related denials, NPI website, etc.
- Manage and complete product/service activation requests by following configuration steps and setting appropriate feature settings in the Brightree operating system.
- Respond to customer requests regarding system setup and activations.
- Accurately document interactions with customers and vendors in Salesforce following standard processes.
- Follow departmental procedures for case tracking and system updates.
- Process customer and internal escalations per department guidelines.
Team Leadership
- Advise enrollment staff, providing training and guidance on enrollment processes.
- Provide training and support on the enrollment process, documentation requirements, and the use of the enrollment portals.
- Be the subject matter expert for the team for best practices, process and workflow definition, and documentation creation and maintenance related to enrolling with multiple clearinghouses.
Let’s talk about Qualifications and Experience
- Bachelor’s degree in healthcare administration, business, or a related field.
- 3+ years of experience in payer enrollment, healthcare claims, commercial payers, and clearinghouse applications.
- Strong understanding of payer policies, enrollment processes, and compliance regulations.
- Excellent leadership and communication skills.
- Strong analytical and problem-solving skills.
- Detail-oriented with exceptional organizational abilities.
- Experience with electronic enrollment systems and healthcare IT solutions.
- Knowledge of healthcare reimbursement models and industry trends.
- Expert knowledge of electronic insurance setups and processes.
- Knowledge of accounts receivable and revenue cycle management.
- Ability to work independently and make sound and timely decisions.
- Excellent organizational, planning, and prioritization skills.
- Demonstrated ability to consistently follow documented processes or task workflows.
- Demonstrated ability to manage detailed tasks with accuracy and completeness.
- Ability to multi-task and manage ongoing task priorities.
- Advanced proficiency with Microsoft Office Suite Products.
- Experience using a CRM software solution (Salesforce).
- Experience with HME/DME software and providing customer service.
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 benefits. This position qualifies for the following benefits package: 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.Individual pay decisions are based on a variety of factors, such as the candidate’s geographic work location, relevant qualifications, work experience, and skills.At ResMed, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current base range for this position is:
$74,000 - $93,000
For remote positions located outside of the US, pay will be determined based the candidate’s geographic work location, relevant qualifications, work experience, and skills.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.
