Job Description

The Offshore Customer Service Representative (CSR), Intake and AR Billing Specialist, supports U.S.-based patients, providers, referral sources, insurance carriers, and internal teams by managing intake, insurance verification, authorization, referral processing, accounts receivable, billing support, and administrative functions within the Durable Medical Equipment (DME) and respiratory care operations.

The role is responsible for reviewing and processing patient referrals and orders, verifying insurance benefits and eligibility, obtaining required documentation and authorizations, coordinating follow up activities, resolving billing, claims, and outstanding account issues, and supporting collections efforts. The representative ensures accurate documentation, timely workflow management, and compliance with HIPAA and company policies while delivering high-quality customer service through phone, email, chat, payer portals, and other communication channels.

Job Duties and Responsibilities

• Support patients throughout the DME service lifecycle, including referral intake, patient registration, insurance verification, authorization, billing, accounts receivable, payment resolution, and ongoing account management.
• Process, review, validate, and maintain patient referrals, physician orders, prescriptions, invoices, medical records, and supporting documentation to ensure completeness, accuracy, and compliance with payer and company requirements.
• Create, update, and maintain accurate patient demographics, insurance information, account records, and billing profiles within company systems.
• Verify insurance eligibility, benefits, coverage, authorization requirements, same and similar history, and patient financial responsibility prior to order processing and claim submission.

Identify the appropriate billing provider, assign accurate charges, and review, validate, and modify AI-generated records, orders, invoices, and system outputs when required.

• Submit, monitor, and track authorization requests, medical records, claim attachments, and supporting documentation through payer portals, electronic systems, and approved communication channels.
• Prepare, review, submit, correct, and resubmit insurance claims for commercial, Medicare, Medicaid, and other third-party payers in accordance with payer-specific billing requirements.
• Review Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), denial codes, payer correspondence, and claim status reports to identify reimbursement issues, denials, underpayments, rejected claims, and required corrective actions.
• Research and resolve denied, unpaid, underpaid, or partially paid claims through claim corrections, adjustments, appeals, reconsiderations, rebilling, payer follow-up, and account resolution activities.
• Manage assigned Accounts Receivable inventories and aging reports by prioritizing follow-up activities, collections, and resolution of outstanding balances based on financial impact and payer deadlines.
• Post payments, adjustments, write-offs, transfers, and patient financial responsibility, including deductibles, copayments, coinsurance, and non-covered balances, in accordance with company policies.
• Respond to inbound and outbound inquiries from patients, providers, referral sources, and insurance carriers regarding order status, documentation requirements, billing questions, claims, authorizations, and account updates.
• Utilize payer portals and healthcare systems, including Blue Shield, Availity, CareFirst, Tricare, UnitedHealthcare (UHC), Cigna, clearinghouses, EMRs, and billing platforms to support intake, billing, claims, collections, and account resolution.
• Maintain detailed account documentation, claim activity records, follow-up notes, and workflow updates to ensure continuity, audit readiness, and accurate account management.
• Monitor work queues and prioritize workload based on turnaround times, aging, operational priorities, payer requirements, and service level expectations.
• Escalate complex billing issues, payer disputes, documentation deficiencies, compliance concerns, and unresolved accounts to the appropriate department or leadership team.
• Collaborate with Intake, Authorizations, Billing, Customer Service, Clinical, and Leadership teams to support efficient order processing, reimbursement, revenue cycle performance, and positive patient outcomes.
• Maintain strict HIPAA compliance and safeguard protected health information while adhering to company policies, payer guidelines, regulatory requirements, and quality standards.
• Meet established productivity, quality, accuracy, turnaround time, denial resolution, and collection performance goals while supporting continuous process improvement and special projects as assigned.
• Demonstrate professionalism, accountability, attention to detail, adaptability, and a patient-focused approach while supporting operational excellence and organizational success.

Job Required Qualification:

• Minimum of 3 years of experience supporting U.S. healthcare, durable medical equipment (DME), revenue cycle management, medical billing, insurance verification, or patient account services.
• Minimum of 1 year of experience in customer service, patient support, healthcare operations, billing, collections, or a call center environment.
• Experience and knowledge in the following areas: Intake, Insurance Verification, Prior Authorizations, Accounts Receivable (AR), Medical Billing, Claims Follow-Up, Denial Management, Payment Posting, Collections, or Patient Financial Services.
• Strong understanding of healthcare insurance concepts, including eligibility verification, benefits, deductibles, coinsurance, patient financial responsibility, authorizations, and claim adjudication.
• Excellent verbal and written English communication skills, with the ability to effectively interact with patients, providers, insurance representatives, and internal stakeholders.
• Strong customer service skills with the ability to handle sensitive patient and financial conversations professionally and empathetically.
• Strong analytical and problem-solving abilities, including the ability to research, investigate, and resolve account, billing, or insurance-related issues.
• High attention to detail and the ability to manage multiple priorities while maintaining accuracy and productivity.
• Proficiency in Microsoft Office applications, including Outlook, Excel, Word, and web-based healthcare systems.
• Typing speed of at least 35 words per minute (WPM) with a high degree of accuracy.
• Demonstrated reliability, accountability, and the ability to work independently in a remote environment.
• Ability to adapt to changing priorities, workflows, payer requirements, and business needs.
• Willingness to work assigned U.S. business hours and support operational requirements as needed.

Preferred Qualifications

• Experience working within the DME industry, particularly supporting respiratory, sleep therapy, mobility, orthopedic, or home medical equipment patients.
• Familiarity with Medicare, Medicaid, commercial insurance plans, DMEPOS guidelines, and reimbursement processes.
• Experience working with healthcare billing, claims management, accounts receivable, patient account, EMR, or practice management systems.
• Experience reviewing EOBs, ERAs, claim denials, appeals, and payer correspondence.
• Background in healthcare call center operations, patient financial services, medical billing, collections, or revenue cycle management.
• Experience supporting both patient intake and revenue cycle functions within a healthcare or DME environment.