Patient Order Management Associate at C4 Technical Services in NEWTON HIGHLANDS, Massachusetts

Patient Order Management Associate

The Patient Order Management Associate manages the patient order. This position is responsible for reviewing medical records and determining if they meet payer policy guidelines, submitting authorizations and checking status of authorizations with payers, running patient benefit information to obtain patient's estimated OOP, and building strong relationships within accounts (clinicians and clinic staff) to retrieve documentation necessary to submit a claim to patient's insurance.

Responsibilities

• Ensure timely processing of orders.
• Review clinician documentation for specific criteria to satisfy payer medical policy requirements.
• Verify patient eligibility and durable medical equipment benefit with health insurance plan(s).
• Determine authorization process and requirements of payers for durable medical equipment.
• Submit and follow up on the status of authorization requests for DME coverage with commercial payers.
• Build strong relationship within accounts (clinicians and clinic staff) to retrieve documentation necessary to submit a claim to patient's insurance.
• Document patient insurance benefits in Tactile's database and verify the information on file is accurate.
• Update and maintain patient information and database records thoroughly and accurately.
• Serve as an expeditor/liaison between Tactile Medical, clinicians, healthcare teams, and patients to obtain all necessary paperwork to drive order to shipment.
• Participate in ongoing team trainings.
• Maintain department service levels including turnaround time.
• Maintain payer portal registration.
• Be a team player. Assist other team members when needed.
• Be a champion for continuous process improvement. Ask questions and continually look for ways to make processes better, faster, or more efficient.
• Contribute to monthly 1:1, small and large group team meetings.
• May participate in training of new team members or field reps, handle product conversions and/or general account support.
• Maintain compliance with internal and external regulations, policies, and procedures for areas of responsibility.
• Other duties as assigned.

QualificationsEducation & ExperienceRequired:

• 1+ years' experience in a medical device, customer service, or call center type role.

Preferred:

• Previous experience in working with patients, clinicians, and payers.
• Previous experience working with FileMaker or Parachute.
• Previous medical device (outpatient DME), insurance, revenue cycle management, reimbursement, or customer service experience.

Knowledge & Skills

• Ability to accurately enter and review patient order information to ensure data integrity and compliance with established protocols.
• Capacity to effectively prioritize tasks and manage workload to meet deadlines and productivity targets in a fast-paced environment.
• Clear and concise verbal and written communication skills to interact with team members, healthcare professionals, and patients professionally and with empathy.
• Flexibility to adjust to changing priorities, processes, and procedures as required to support the needs of the department and organization.
• Willingness to work collaboratively with colleagues to achieve common goals and provide support as needed to ensure the smooth functioning of the team.
• Ability to identify and resolve routine issues or escalate them appropriately to ensure timely resolution and minimize disruption to order processing workflows.
• Dedication to delivering high-quality service to internal and external customers by addressing inquiries, concerns, and requests promptly and courteously.
• Proficiency in using computer systems and software applications relevant to order management tasks, with a willingness to learn and adapt to new technologies as needed.
• Understanding of and commitment to adhering to relevant regulations, policies, and procedures governing patient order management activities.
• Demonstrated professionalism and integrity in handling confidential patient information and representing the organization positively in all interactions.