Job Description

Job Duties and Responsibilities:

• Manage a high volume of patient referrals, orders, and accounts while meeting established productivity, quality, and service level expectations.
• Handle inbound and outbound communication through calls, chats, portal requests, and emails from patients, referral sources, providers, insurance representatives, and internal staff during assigned U.S. business hours, based on business needs.
• Review, process, and validate incoming referrals and orders for respiratory and DME equipment.
• Accurately document all patient, referral, insurance, provider, and order information within the company's EMR, DME software, and supporting systems.
• Verify insurance eligibility, benefits, coverage requirements, and patient financial responsibility prior to order processing.
• Review and determine authorization requirements, submit authorization requests, track status, complete follow-ups, and obtain approvals as needed.
• Code insurance accurately, verify medical and pharmacy benefits, run pharmacy test claims when required, and contact insurance carriers to validate benefit information.
• Conduct outbound follow-up with patients, providers, referral sources, insurance companies, and internal teams to obtain missing documentation, clarify requirements, and facilitate order progression.
• Review orders for completeness and identify missing documentation, signatures, chart notes, prescriptions, or supporting records required for processing.
• Monitor assigned work queues and prioritize tasks based on aging, urgency, service level expectations, and operational requirements.
• Review patient accounts and referral history to ensure accurate order processing and continuity of care.
• Coordinate with Scheduling, Authorizations, Resupply, Billing, Customer Service, Clinical, and Sales teams to support efficient workflow progression.
• Educate patients on insurance requirements, authorization processes, scheduling expectations, equipment setup timelines, billing responsibilities, rental versus purchase programs, and next steps in the order process.
• Assist with patient onboarding activities and ensure patients receive accurate information regarding equipment and service expectations.
• Review eligibility and order readiness requirements before transitioning orders to downstream departments.
• Perform insurance reverifications and ongoing eligibility reviews as required by payer guidelines and company processes.
• Process account updates, insurance changes, demographic updates, and provider information changes accurately and timely.
• Escalate complex issues, sensitive situations, payer concerns, and patient complaints to the appropriate leadership team in accordance with established procedures.
• Maintain HIPAA compliance and protect all patient health information in accordance with company policies and regulatory requirements.
• Meet or exceed established key performance indicators, including productivity, quality, turnaround time, attendance, first-contact resolution, and customer experience metrics.
• Adapt to workflow changes, client requirements, process improvements, and system enhancements while maintaining performance standards.
• Participate in ongoing training, calibration sessions, quality reviews, team meetings, and coaching activities.
• Support special projects, operational initiatives, cross-functional assignments, and additional responsibilities as required by business needs.
• Demonstrate professionalism, accountability, teamwork, and a patient first approach in all interactions.

Job Required Qualification:

• Minimum 3 years of experience in U.S. healthcare, insurance, revenue cycle, or DME environment
• At least 1 year of experience in a customer service or call center setting
• Experience in intake, resupply/reorder, billing, payment processing, or account resolution in healthcare
• Strong understanding of insurance benefits, deductibles, coinsurance, and patient billing
• Strong English communication skills, written and verbal
• Excellent customer service and interpersonal skills
• Strong attention to detail and ability to work independently
• Proficiency in MS Word, Excel, and Outlook
• Typing speed of at least 35 WPM with high accuracy
• Proven attendance and reliability
• Comfortable working with diverse teams and clients
• Basic math skills
• Willing to work U.S. business hours

Preferred Qualifications:

• DME experience including CPAP, oxygen, or respiratory equipment
• Familiarity with Medicare DMEPOS guidelines
• Experience with billing systems such as Truesight, Collect Plus, or similar tools
• Background in healthcare call center or patient financial services