Salary $45,988 - $51,001 a year job type full-time
Full job description
The kestra team has over 400 years of experience in the external and internal cardiac medical device marketsThe company was founded in 2014 by industry leaders inspired by the opportunity to unite modern wearable technologies with proven device therapiesKestra’s solutions combine high quality and technical performance with a wearable design that provides the greatest regard for patient comfort and dignityInnovating 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 equipmentThis 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 mannerFrequently, this position discusses insurance benefits, out-of-pocket costs, deductibles, and payment methods with patientsThe dme customer order specialist is knowledgeable in kestra dme offerings, its features and benefits, and process to uphold its standards for excellence.
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 referralsConfirm medical records meet medical necessity based on applicable insurance guidelinesPromptly 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 softwareResponsible 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 determinationAssist 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 associatesSend 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 coverageHours on-call and worked may include evenings, weekends, and holidays.
Adhere to pledge of confidentiality
O information regarding a patient of this company shall not be released to any source outside of this company without the signed permission of the patientFurthermore, information will only be released internally on a need-to-know basisAll 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.
Passion: contagious excitement about the company – sense of urgencyCommitment to continuous improvement.
Integrity: commitment, accountability, and dedication to the highest ethical standards.
Collaboration/teamwork: inclusion of team member regardless of geography, position, and product or service.
Action/results: high energy, decisive planning, timely execution.
Innovation: generation of new ideas from original thinking.
Customer focus: exceed customer expectations, quality of products, services, and experience always present of mind.
Emotional intelligence: recognizes, understands, manages one’s own emotions and is able to influence othersA critical skill for pressure situations.
High school diploma or ged
Must reside on west coast in us
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 informationE.gReference #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
Experience with hcpcs procedure codes and icd-10 codes
Remote, yet fast paced work environment
Noise level typical of an open office environment
Frequent repetitive motions that may include wrists, hands and/or fingers, such as keyboard and mouse usage
Frequent stationary position, often sitting for prolonged periods of time
Occasional bending and stooping
Occasional lifting up to 20 pounds
Occasional travel, less than 5%