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) Prior Authorization 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 CST hours (M-F).
ESSENTIAL DUTIES:
- 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.
COMPETENCIES:
- Passion: Contagious excitement about the company – sense of urgency. Commitment 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 others. A critical skill for pressure situation
Requirements
Education/Experience Required:
- High School Diploma or GED
- 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
Preferred:
- Experience with HCPCS procedure codes and ICD-10 codes
WORK ENVIRONMENT:
- Remote, yet fast paced work environment
- Availability to work evenings and weekends
- Noise level typical of an open office environment
- Drug-free
PHYISCAL DEMANDS:
- 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
TRAVEL:
- Occasional travel, less than 5%
OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the Team Member. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
Benefits
Kestra offers a very competitive benefit package including Medical, Dental, 401K with Match, etc.
Pay equity is an important part of Kestra’s Culture. Our compensation ranges are guided by national and local salary surveys and take into consideration experience level and internal equity. Each role is benchmarked based on the job description provided. If your qualifications and/or experience level are outside of the posted position, we encourage you to apply as we are growing fast and roles that are coming soon may not be posted.
Salary: Annualized between $57,000 and $69,000. Depending on experience and location.
Kestra Medical Technologies is an equal opportunity employer. Kestra Medical Technologies does not discriminate on the basis of race, color, religion, national origin, veteran status, disability, age, sexual orientation, gender identity and/or expression, marital status, or any other characteristic protected by law.
We are unable to sponsor or take over sponsorship of employment visas at this time. Applicants must be eligible to work for any employer in the U.S.
Kestra manufactures and provides life-saving products regulated by the Federal Food and Drug Administration and under contract with Medicare. Kestra maintains a drug free workplace and testing is a condition of employment.
