DME Intake Management Specialist

About the position

The Intake Management Specialist is responsible for DME order qualification based on insurance company criteria for Brightree customers. In addition, this role is responsible for identifying and following policies, procedures and systems for quality assurance as directed by Medicare, Medicaid and Private insurance plans. This position will assist in creating and revising our standard operating procedures and educate our partners, worldwide vendors, and internal teams on those procedures. Responsible for quality assurance of work performed by internal team members.

Responsibilities

• Understanding all general rules, qualification guidelines, and verification methods to get optimal reimbursement from the insurance companies and Brightree customers for which they are assigned.
• Responsible for resolving and routing incoming salesforce cases and escalations from customers.
• Responsible for the order processing performance of Brightree customers by ensuring accuracy.
• Ensure all payor qualification guidelines are met, including but not limited to insurance verification, Prior Authorization obtainment (where required), clinical guidelines met with payor required documentation on file, reviewing dispensing timeframes to ensure post-delivery claim payment is achieved.
• Ensure that the qualification methodology for each payer is documented to realize maximum reimbursement.
• Propose changes and updates to the configuration of the customers Brightree system including but not limited to CMN settings, form types, narratives/quantity, Prior Authorization settings, etc.
• Continuously improve current business and system processes by creating, redefining, and maintaining standard operating procedures (SOPs) to ensure maximum efficiency in business and system processes; seek input on improved strategies and processes to help achieve goals; implement new processes and system practices to achieve the goal of reducing time to market for new products while maintaining the highest quality products in the market.
• Assist in the onboarding and offboarding of our clients from the different Brightree systems.
• Prepares, monitors, and submits reports to team lead as needed including but not limited to: Quality Assurance Reporting, Service Level Agreement Reporting, Credit Card Obtainment Reporting.
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals.
• Collaborates with worldwide resources to ensure effective knowledge, information sharing, and quick resolution of service performance issues.
• Maintains patient confidentiality and function within the guidelines of HIPAA.

Requirements

• High school diploma; equivalent combination of education and experience will be considered.
• Minimum of 1 year of DME qualification/customer service or accounts receivable experience required.
• Minimum of 1 year of experience working in & maintaining HIPAA standards.
• Highly skilled in using computers & Microsoft products (Excel and Word) is required.
• Highly motivated in customer service, qualification, and document management to work with our internal and external customers on the phone or via software applications.
• Math aptitude.
• Strong problem-solving skills focused on resolving complex order qualification issues.
• An effective communicator with strong oral, written, and persuasive skills and capability to deal with people at all levels in the organization and the public in a professional manner.
• Exceptional organizational skills with a high level of attention to detail and the ability to multitask.
• Self-starter, results driven, highly motivated, high energy.
• Proven track record of working towards and exceeding metrics strongly preferred.

Nice-to-haves

• A 2-year degree or additional college coursework.
• 5 years of experience in a healthcare customer service or reimbursement role.

Benefits

• Comprehensive medical, vision, dental, and life insurance.
• 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).
• Tuition assistance.
• Fifteen days Paid Time Off (PTO) in the first year of employment.
• 11 paid holidays plus 3 floating days.
• 14 weeks of primary caregiver or two weeks of secondary caregiver leave when welcoming new family members.
• Annual cash bonus payment based on performance.
• Eligibility for stock equity based on performance.