Customer Order Specialist - Sat - Wed, 1st Shift (PST/MST)

Kestra Medical Technologies, Inc

4h•$60,000 - $65,000•Remote

About The Position

The Kestra team has over 400 years of experience in the external and internal cardiac medical device markets. The company was founded in 2014 by industry leaders inspired by the opportunity to unite modern wearable technologies with proven device therapies. Kestra’s solutions combine high quality and technical performance with a wearable design that provides the greatest regard for patient comfort and dignity. Innovating versatile new ways to deliver care, Kestra is helping patients and their care teams harmoniously monitor, manage, and protect life. The Durable Medical Equipment (DME) Customer Order Specialist is responsible for performing all tasks and communication related to intake and processing of prescriptions and/or physician work orders, as well as patient information concerning the rental of durable medical equipment. This role regularly communicates with patients, health care providers, Team Members, Health Insurance (payor) representatives and referral sources as it relates to competently and efficiently requesting and obtaining payor prior authorizations on behalf of patients in a friendly, caring, and professional manner. Frequently, this position discusses insurance benefits, out-of-pocket costs, deductibles, and payment methods with patients. The DME Customer Order Specialist is knowledgeable in Kestra DME offerings, its features and benefits, and process to uphold its standards for excellence. We are looking for someone who is comfortable working PST hours - 1st Shift (Sat - Wed).

Requirements

High School Diploma or GED
Fluent in both English and Spanish
Two (2) or more years of experience with Insurance verifications, which include gathering prior authorization required documents and submitting/following-up prior authorizations requests to payors
Direct experience using payor portals
Highly accurate with pertinent information. e.g. reference #s, dates, spelling of names, ID#s, phone #s, email addresses
Consistently detailed oriented and thorough
Advanced written and verbal communication skills, to include excellent grammar
Advanced reading and comprehension abilities
Advanced analytical skills and detail-oriented
Advanced multi-tasking skills
Advanced organizational and prioritization skills, with strong ability to meet strict deadlines
Proficient typing skills
Proficient with Microsoft Word, Microsoft Outlook, Adobe Acrobat, general internet research, and beginner knowledge of Microsoft Excel
Familiarity with PDF editing

Nice To Haves

Experience with HCPCS procedure codes and ICD-10 codes

Responsibilities

Coordinate with sales representatives, physician's office, and applicable internal/external personnel in regard to medical records and information needed to obtain pre-authorization and benefits upon intake of new patient referrals. Confirm medical records meet medical necessity based on applicable insurance guidelines. Promptly follow-up on patient referrals, physician prescriptions and/or physician work orders
Verify eligibility and benefits of patient health insurance specific to Durable Medical Equipment (DME) by contacting insurance companies by phone, accessing insurance website portals, and utilizing Kestra’s medical billing software. Responsible for verification of active coverage, deductibles, accumulations, coinsurance, and pre-authorization requirements
Initiate, track, and complete pre-authorizations requests, including notifying applicable parties of the determination. Assist with appeals for Prior Authorization denials
Upon authorization, place orders for Durable Medical Equipment, notify, and dispatch patient product fitters
Review information and/or reports to confirm scheduled fitters arrive at destination in a timely manner
Review “Delivery Tickets” to confirm they were completed accurately and signed
Perform data entry into medical billing software and other software (Salesforce) including patient demographics, prescribing physician’s information, insurance payor information, HCPCS procedure codes, ICD-10 diagnosis codes, etc
Regularly contact and communicate with Team Members, insurance companies, vendors, sales representatives, doctor’s offices, practitioners, clearinghouses, billers, and other applicable companies and associates. Send updates on prior authorizations, claims, patient benefits, orders, and other information as appropriate
Regularly communicate with patients to discuss their insurance benefits, out-of-pocket costs, and product payment arrangements
Escalate issues within insurance carriers when not able to obtain reasonable information
Answer incoming phone calls to office and route messages accordingly
Routinely export/import data from one software to another software
Create forms through auto-populating data into custom fields
Perform detailed notetaking with high accuracy on pertinent information
Utilize Adobe Acrobat Pro to create and edit PDF files: insert/move/delete pages; edit/add/redact text; save meta data, create templates, export/import data through plugin, etc
Consistently follow up with patients to confirm patient satisfaction
Accurately complete forms/applications and send out to applicable destination
Exercise patience and empathy when communicating with patients and customers
Be aware of and adapt to changes in medical regulations and processes
Participate in on-call and off hours coverage. Hours on-call and worked may include evenings, weekends, and holidays
Adhere to Pledge of Confidentiality
Information regarding a patient of this company shall not be released to any source outside of this company without the signed permission of the patient. Furthermore, information will only be released internally on a need-to-know basis. All Team Members will not discuss patient cases outside the office or with anyone not employed by this company unless they are directly involved with the patient’s case.