Brightree is a wholly owned subsidiary of ResMed (NYSE: RMD, ASX: RMD).
When you work at Brightree, it’s more than just a job. You’ll be part of a team that’s driving innovation and leading the way in cloud-based patient management software.
The technology allows us to provide the tools for better outcomes but at our heart, we’re really about people. We strive to positively impact our customers’ businesses and the lives of patients every single day.
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.
Let’s talk about 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
Let’s talk about Qualifications:
- 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.
- A 2-year degree or additional college coursework
- 5 years of experience in a healthcare customer service or reimbursement role
We are shaping the future at ResMed, and we recognize the need to build on and broaden our existing skills and continue to attract and retain the world’s best talent. We work hard to offer holistic benefits packages, provide flexible work arrangements, cultivate a workforce culture that allows employees to grow personally and professionally, and deliver competitive salaries to our team members. Employees scheduled to work 30 or more hours per week are eligible for benefits. This position qualifies for the following benefits package: comprehensive medical, vision, dental, and life, 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), and tuition assistance.
Employees accrue fifteen days Paid Time Off (PTO) in their first year of employment, receive 11 paid holidays plus 3 floating days and are eligible for 14 weeks of primary caregiver or two weeks of secondary caregiver leave when welcoming new family members. Individual pay decisions are based on a variety of factors, such as the candidate’s geographic work location, relevant qualifications, work experience, and skills.
Subject to the absolute discretion of the company, this role is eligible for an annual cash bonus payment based on company, business unit, and/or individual performance.
Subject to the absolute discretion of the company, this role may be eligible to receive stock equity based on company, business unit, and/or individual performance.
Base Pay Range for this position:
$16.00 – 24.00 USD Hourly
For remote positions located outside of the US, pay will be determined based the candidate’s geographic work location, relevant qualifications, work experience, and skills.
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